MEDICARE: MRS. SHELLEY MORRIS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SW7364	FL

General Provider Information

NPI Number	:	1053346288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELLEY MORRIS LCSW

Provider Business Mailing Address
First Line	:	11313 S HARVARD AVE
Second Line	:	SUITE B
City	:	TULSA
State	:	OK
Zip	:	74137-7809
Country	:	US
Telephone Number	:	850-682-5332
Fax Number	:	850-682-8486

Provider Business Practice Location Address
First Line	:	150 E REDSTONE AVE
Second Line	:	SUITE B
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-5357
Country	:	US
Telephone Number	:	850-682-5332
Fax Number	:	850-682-8486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/22/2016

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