Healthcare Provider Details

I. General information

NPI: 1316803042
Provider Name (Legal Business Name): MIKE MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 E PARK AVE
NILES OH
44446-2352
US

IV. Provider business mailing address

3913 EDINBURGH DR
YOUNGSTOWN OH
44511-1129
US

V. Phone/Fax

Practice location:
  • Phone: 330-544-8005
  • Fax: 330-544-9379
Mailing address:
  • Phone: 630-854-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: