Healthcare Provider Details

I. General information

NPI: 1083536668
Provider Name (Legal Business Name): JESSICA MICHELLE MORRIS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 W SHAW AVE STE D1
FRESNO CA
93711-3513
US

IV. Provider business mailing address

1616 W SHAW AVE STE D1
FRESNO CA
93711-3513
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-3900
  • Fax:
Mailing address:
  • Phone: 559-431-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number164673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: