Healthcare Provider Details

I. General information

NPI: 1811845068
Provider Name (Legal Business Name): CHARLIE 6017655661 MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 911
MOUNT OLIVE MS
39119-0911
US

IV. Provider business mailing address

PO BOX 911
MOUNT OLIVE MS
39119-0911
US

V. Phone/Fax

Practice location:
  • Phone: 601-765-5661
  • Fax:
Mailing address:
  • Phone: 601-765-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number6Y2012348
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: