Basic Information
| Provider Information | |||||||||
| NPI: | 1235260852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRISSEY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | RAYMOND | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A. ATR-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2835 SE COLT DR | ||||||||
| Address2: | #418 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972024458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032380705 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7630 NORTON AVE | ||||||||
| Address2: | #4 | ||||||||
| City: | WEST HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900465438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238760550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 01/15/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.