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General NPI Number Information
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NPI Number | 1669118402
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Entity Type | Individual
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Provider Name | PRUDENCE MORRIS LPC
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Gender | Female
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 2634 HIGHWAY 109 STE E
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City | WILDWOOD
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State | MO
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Zip | 63040-1160
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Country | US
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Telephone | 636-271-5571
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Fax |
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Provider Business Mailing Address
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Address Line | 312 TIMBER MEADOW DR
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City | WILDWOOD
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State | MO
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Zip | 63011-1991
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Country | US
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Telephone | 330-501-1787
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2020036182
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License Number State | MO
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