Healthcare Provider Details

I. General information

NPI: 1669162418
Provider Name (Legal Business Name): SUSAN OLIVIA MORRIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 S YELLOWSTONE HWY STE 3201
REXBURG ID
83440-6200
US

IV. Provider business mailing address

EAST IDAHO MENTAL HEALTH 59 SOUTH YELLOWSTONE HIGHWAY #3201
REXBURG ID
83448
US

V. Phone/Fax

Practice location:
  • Phone: 208-359-2101
  • Fax: 208-359-2101
Mailing address:
  • Phone:
  • Fax: 208-359-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19554
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: