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General NPI Number Information
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NPI Number | 1295922185
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Entity Type | Individual
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Provider Name | JERRY BEN MORRIS B.S.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1333 E RICHMOND AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-6116
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Country | US
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Telephone | 817-926-7041
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Fax | 817-926-7461
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Provider Business Mailing Address
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Address Line | 6901 REBEL RD
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City | FOREST HILL
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State | TX
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Zip | 76140-1815
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Country | US
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Telephone | 817-293-7347
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Fax | 817-926-7461
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | TX
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