Healthcare Provider Details

I. General information

NPI: 1154310894
Provider Name (Legal Business Name): ELISSA MORRIS M.S., CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELISSA JUBELIER M.S., CGC

II. Dates (important events)

Enumeration Date: 10/16/2005
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE SUITE 160
VANCOUVER WA
98664-1989
US

IV. Provider business mailing address

6011 SW JAN TREE CT
PORTLAND OR
97219-1152
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-6046
  • Fax: 360-514-6075
Mailing address:
  • Phone: 503-252-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: