Healthcare Provider Details

I. General information

NPI: 1124236609
Provider Name (Legal Business Name): CAROLYN THOMAS MORRIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YUCCA STREET # 2 SHIPROCK TREATMENT CENTER
SHIPROCK NM
87420-1830
US

IV. Provider business mailing address

PO BOX 1744
SHIPROCK NM
87420-1744
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-1050
  • Fax:
Mailing address:
  • Phone: 505-301-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3584
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: