Provider Demographics
NPI:1518793850
Name:MORSE, DOUGLAS OZWALD
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:OZWALD
Last Name:MORSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95901-7326
Mailing Address - Country:US
Mailing Address - Phone:530-788-4951
Mailing Address - Fax:
Practice Address - Street 1:1865 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:LINDA
Practice Address - State:CA
Practice Address - Zip Code:95901-7326
Practice Address - Country:US
Practice Address - Phone:530-788-4951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY9131184106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician