Healthcare Provider Details

I. General information

NPI: 1376471219
Provider Name (Legal Business Name): DANIEL TIMOTHY MORRIS LSAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 JACKSON ST NE
ALBUQUERQUE NM
87108-1339
US

IV. Provider business mailing address

2851 PORTO ST SW
ALBUQUERQUE NM
87121-5417
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-1306
  • Fax:
Mailing address:
  • Phone: 505-526-4235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2026-0368
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: