Provider Demographics
NPI:1245446376
Name:MORRISON, NANCY CAROL (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:CAROL
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3105
Mailing Address - Country:US
Mailing Address - Phone:618-624-5964
Mailing Address - Fax:314-977-3214
Practice Address - Street 1:701 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2665
Practice Address - Country:US
Practice Address - Phone:618-632-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000313101YP2500X
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist