=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831558022
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MORRISSEY INSTITUTE, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2016
-----------------------------------------------------
Last Update Date | 03/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 W 14TH ST
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81003-2708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-989-8431
-----------------------------------------------------
Fax | 719-281-3182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 W 14TH ST
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81003-2708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-989-8431
-----------------------------------------------------
Fax | 719-281-3182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | DR. MICHELLE MORRISSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 719-989-8431
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 920
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------