MEDICARE: ILENE MORRISON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		CA
2	101YM0800X	Mental Health Counselor	PSY12928	CA

General Provider Information

NPI Number	:	1093058778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILENE MORRISON PH.D.

Provider Business Mailing Address
First Line	:	2345 CALIFORNIA ST STE 7
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2779
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 14TH ST STE 711
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-2706
Country	:	US
Telephone Number	:	510-663-4595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2013
Last Update Date	:	04/13/2023

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