Provider Demographics
NPI:1972952216
Name:MORRIS, MICHAEL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MORRIS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E D ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3177
Mailing Address - Country:US
Mailing Address - Phone:707-799-9500
Mailing Address - Fax:
Practice Address - Street 1:405 E D ST
Practice Address - Street 2:SUITE 108
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3177
Practice Address - Country:US
Practice Address - Phone:707-799-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80039106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist