Healthcare Provider Details

I. General information

NPI: 1083111934
Provider Name (Legal Business Name): ELIJAH PAUL MORROW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15501 SAN PABLO AVE # G239
RICHMOND CA
94806-5848
US

IV. Provider business mailing address

PO BOX 562
COALINGA CA
93210-0562
US

V. Phone/Fax

Practice location:
  • Phone: 888-524-5122
  • Fax:
Mailing address:
  • Phone: 503-884-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY32414
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: