Healthcare Provider Details

I. General information

NPI: 1851620074
Provider Name (Legal Business Name): BURL MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7509 CHARLESTOWN PIKE
CHARLESTOWN IN
47111-9623
US

IV. Provider business mailing address

900 FULTON ST
JEFFERSONVILLE IN
47130-4153
US

V. Phone/Fax

Practice location:
  • Phone: 812-256-4686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: