Provider Demographics
NPI:1982184610
Name:MORRIS, CHARLENE W (LMHC)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:W
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121196
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32912-1196
Mailing Address - Country:US
Mailing Address - Phone:321-345-6831
Mailing Address - Fax:
Practice Address - Street 1:2475 PALM BAY RD NE STE 145-23
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32905-3317
Practice Address - Country:US
Practice Address - Phone:321-345-6831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15456101YM0800X
FLMH18406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH18406OtherLICENSED MENTAL HEALTH COUNSELOR