Healthcare Provider Details

I. General information

NPI: 1447019286
Provider Name (Legal Business Name): MR. KENNETH DEAN MORRIS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17505 N 79TH AVE STE 410
GLENDALE AZ
85308-8732
US

IV. Provider business mailing address

1970 N HARTFORD ST UNIT 81
CHANDLER AZ
85225-7303
US

V. Phone/Fax

Practice location:
  • Phone: 623-800-7980
  • Fax:
Mailing address:
  • Phone: 480-773-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: