Healthcare Provider Details

I. General information

NPI: 1639934110
Provider Name (Legal Business Name): MADELEINE GRACE MORRIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADDIE GRACE MORRIS LCSW

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20185 E OCOTILLO RD STE 102
QUEEN CREEK AZ
85142-7663
US

IV. Provider business mailing address

32449 N GARY RD UNIT 5205
SAN TAN VALLEY AZ
85143-5915
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-3474
  • Fax:
Mailing address:
  • Phone: 480-927-3813
  • Fax: 480-393-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23814
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: