Basic Information
| Provider Information | |||||||||
| NPI: | 1598137549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKIPPER | ||||||||
| FirstName: | MORRIS | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MHS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 ARNOULD BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705066218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372305700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 116 BERTRAND DR | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705065632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372618781 | ||||||||
| FaxNumber: | 3372618784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2015 | ||||||||
| LastUpdateDate: | 05/10/2018 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.