Basic Information
Provider Information
NPI: 1699976043
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORRIS
FirstName: CHRISTOPHER
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 933 BRADBURY DR SE
Address2: SUITE 2222
City: ALBUQUERQUE
State: NM
PostalCode: 871064374
CountryCode: US
TelephoneNumber: 5052723120
FaxNumber:  
Practice Location
Address1: 3001 BROADMOOR BLVD NE
Address2:  
City: RIO RANCHO
State: NM
PostalCode: 871442100
CountryCode: US
TelephoneNumber: 5059947000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/31/2007
LastUpdateDate: 02/06/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X3507AZN Behavioral Health & Social Service ProvidersPsychologistClinical
103TC0700X0909NMY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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