Basic Information
| Provider Information | |||||||||
| NPI: | 1629263736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3151 N RUSHWOOD ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672261228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162597766 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 N WOODLAWN ST STE 3105 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166511230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 9501 | KS | N | Behavioral Health & Social Service Providers | Social Worker | 106H00000X | 2725 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.