Healthcare Provider Details

I. General information

NPI: 1407575202
Provider Name (Legal Business Name): MATTHEW GERALD MORELOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 SW 4TH AVE STE 2
ONTARIO OR
97914-2100
US

IV. Provider business mailing address

PO BOX 658
ONTARIO OR
97914-0658
US

V. Phone/Fax

Practice location:
  • Phone: 541-216-6068
  • Fax: 541-216-6094
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: