Healthcare Provider Details

I. General information

NPI: 1255173910
Provider Name (Legal Business Name): ELONZA MORRIS III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 N MONROE ST
TALLAHASSEE FL
32303-7015
US

IV. Provider business mailing address

4909 N MONROE ST
TALLAHASSEE FL
32303-7015
US

V. Phone/Fax

Practice location:
  • Phone: 850-583-0068
  • Fax:
Mailing address:
  • Phone: 850-583-0068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: