Provider Demographics
NPI:1831510601
Name:MORRIS, COUNTESS (RBT)
Entity type:Individual
Prefix:
First Name:COUNTESS
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 S WEST SHORE BLVD APT 1209
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1020
Mailing Address - Country:US
Mailing Address - Phone:850-597-3944
Mailing Address - Fax:
Practice Address - Street 1:8254 118TH AVENUE N
Practice Address - Street 2:STE 100
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5027
Practice Address - Country:US
Practice Address - Phone:727-541-5304
Practice Address - Fax:727-546-8527
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-22
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
FLRBT-15-10995247200000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other