Healthcare Provider Details

I. General information

NPI: 1679740724
Provider Name (Legal Business Name): KATHLEEN A MORRIS LMSW LADCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 HARBOR RD
GROVE OK
74344-3505
US

IV. Provider business mailing address

1115 HARBOR RD
GROVE OK
74344-3505
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-4434
  • Fax: 918-786-4435
Mailing address:
  • Phone: 918-786-4434
  • Fax: 918-786-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: