Provider Demographics
NPI:1669118402
Name:MORRIS, PRUDENCE (LPC)
Entity type:Individual
Prefix:MRS
First Name:PRUDENCE
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 TIMBER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1991
Mailing Address - Country:US
Mailing Address - Phone:330-501-1787
Mailing Address - Fax:
Practice Address - Street 1:2634 HIGHWAY 109 STE E
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1160
Practice Address - Country:US
Practice Address - Phone:636-271-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020036182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health