Provider Demographics
NPI:1831170034
Name:MORRIS, JERRY A JR (PSYD, MBA, ABPP)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:A
Last Name:MORRIS
Suffix:JR
Gender:M
Credentials:PSYD, MBA, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12541 FOSTER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2307
Mailing Address - Country:US
Mailing Address - Phone:913-735-0955
Mailing Address - Fax:
Practice Address - Street 1:12541 FOSTER ST STE 200
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2307
Practice Address - Country:US
Practice Address - Phone:913-735-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000245101YP2500X
MO00324103TC0700X
MO300028106H00000X
KS1264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO09708020OtherBLUE CROSS BLUE SHIELD
KS100240270AMedicaid
MO493219703Medicaid
KS100240270AMedicaid