Provider Demographics
NPI:1053346288
Name:MORRIS, SHELLEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11313 S HARVARD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7809
Mailing Address - Country:US
Mailing Address - Phone:850-682-5332
Mailing Address - Fax:850-682-8486
Practice Address - Street 1:150 E REDSTONE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5357
Practice Address - Country:US
Practice Address - Phone:850-682-5332
Practice Address - Fax:850-682-8486
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7364104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ09125Medicare UPIN
FLZ051WMedicare ID - Type UnspecifiedMEDICARE