Basic Information
| Provider Information | |||||||||
| NPI: | 1720402134 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | TAMMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 507 WOODLAND AVE SW | ||||||||
| Address2: | |||||||||
| City: | NORTH CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447203050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309369421 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1620 MARKET AVE S | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304580393 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2014 | ||||||||
| LastUpdateDate: | 02/06/2014 | ||||||||
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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 | 101YP2500X | C.0800073-CR | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 104100000X | S.0031334 | OH | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.