Healthcare Provider Details

I. General information

NPI: 1457516924
Provider Name (Legal Business Name): MR. BOBBY MCMORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 24TH ST
RICHMOND CA
94804-1804
US

IV. Provider business mailing address

256 24TH ST
RICHMOND CA
94804-1804
US

V. Phone/Fax

Practice location:
  • Phone: 510-374-3467
  • Fax: 510-374-7274
Mailing address:
  • Phone: 510-374-3467
  • Fax: 510-374-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: