Provider Demographics
NPI:1295922185
Name:MORRIS, JERRY BEN (BS)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:BEN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6901 REBEL RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1815
Mailing Address - Country:US
Mailing Address - Phone:817-293-7347
Mailing Address - Fax:817-926-7461
Practice Address - Street 1:1333 E RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-6116
Practice Address - Country:US
Practice Address - Phone:817-926-7041
Practice Address - Fax:817-926-7461
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness