Provider Demographics
NPI:1750411633
Name:MORRIS, MICHAEL JOHN (PHD IN PSYCHOLOGY)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PHD IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7530 LUCERNE DR
Mailing Address - Street 2:#115
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6557
Mailing Address - Country:US
Mailing Address - Phone:440-243-5530
Mailing Address - Fax:440-243-5530
Practice Address - Street 1:7530 LUCERNE DR
Practice Address - Street 2:#115
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-6557
Practice Address - Country:US
Practice Address - Phone:440-243-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH3843103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0689447Medicaid
11576317OtherCAQH NATIONAL
11576317OtherCAQH NATIONAL