Healthcare Provider Details

I. General information

NPI: 1407896756
Provider Name (Legal Business Name): STEPHEN B. MORRIS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 LOUISE AVE
SALT LAKE CITY UT
84109-2224
US

IV. Provider business mailing address

3167 LOUISE AVE
SALT LAKE CITY UT
84109-2224
US

V. Phone/Fax

Practice location:
  • Phone: 801-485-2362
  • Fax: 801-485-1145
Mailing address:
  • Phone: 801-485-2362
  • Fax: 801-485-1145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1143812501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1143812501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: