Healthcare Provider Details

I. General information

NPI: 1053063180
Provider Name (Legal Business Name): TAYSUE ETHEL MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17904 GEORGIA AVE
OLNEY MD
20832-2239
US

IV. Provider business mailing address

18500 OWL RUN WAY
GERMANTOWN MD
20874-2105
US

V. Phone/Fax

Practice location:
  • Phone: 240-304-3327
  • Fax:
Mailing address:
  • Phone: 240-848-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP11718
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: