Basic Information
| Provider Information | |||||||||
| NPI: | 1922428614 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | LAUREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 TEXAS ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196920727 | ||||||||
| FaxNumber: | 6196920785 | ||||||||
| Practice Location | |||||||||
| Address1: | 5005 TEXAS ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196920727 | ||||||||
| FaxNumber: | 6196920785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 04/21/2014 | ||||||||
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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 | 101Y00000X | CA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.