=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063569325
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUGENE MARTIN MORRISON JR. LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 565 CASTRO ST
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94041-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-903-2881
-----------------------------------------------------
Fax | 650-903-2870
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1588 HOMESTEAD RD SUITE 6
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95050-4783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-507-1447
-----------------------------------------------------
Fax | 408-984-0135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MFC22367
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------