Healthcare Provider Details

I. General information

NPI: 1083153225
Provider Name (Legal Business Name): KYLE MORRISON PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600H EDEN RD
LANCASTER PA
17601-4205
US

IV. Provider business mailing address

240 STONE MILL RD APT E106
LANCASTER PA
17603-4624
US

V. Phone/Fax

Practice location:
  • Phone: 717-397-1400
  • Fax: 717-509-4066
Mailing address:
  • Phone: 847-254-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS018226
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: