Healthcare Provider Details

I. General information

NPI: 1154625614
Provider Name (Legal Business Name): MARKISE MORRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 WESTGATE AVE
REDDING CA
96001
US

IV. Provider business mailing address

3880 WESTGATE AVE
REDDING CA
96001-2205
US

V. Phone/Fax

Practice location:
  • Phone: 707-977-0500
  • Fax:
Mailing address:
  • Phone: 707-977-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF68807
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: