Healthcare Provider Details

I. General information

NPI: 1407872377
Provider Name (Legal Business Name): JARED D. MORRISON CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E ELVA ST
IDAHO FALLS ID
83401-2801
US

IV. Provider business mailing address

1 KALISA WAY STE 101
PARAMUS NJ
07652-3508
US

V. Phone/Fax

Practice location:
  • Phone: 208-523-4795
  • Fax:
Mailing address:
  • Phone: 888-948-6789
  • Fax: 877-345-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-24551
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: