Healthcare Provider Details

I. General information

NPI: 1790216687
Provider Name (Legal Business Name): JESSICA NICOLE MORRISS LPCC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA NICOLE RANNOW LADC

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date: 10/10/2017
Reactivation Date: 08/07/2020

III. Provider practice location address

1801 AMERICAN BLVD E STE 8
BLOOMINGTON MN
55425-1230
US

IV. Provider business mailing address

1801 AMERICAN BLVD E STE 8
BLOOMINGTON MN
55425-1230
US

V. Phone/Fax

Practice location:
  • Phone: 952-767-2267
  • Fax:
Mailing address:
  • Phone: 612-767-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number303044
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4024
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4024
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4024
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number303044
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: