MEDICARE: TIA JENICE MORRIS MSW, ACSW, LCSW

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	1041C0700X	Clinical Social Worker	2010036934	MO

General Provider Information

NPI Number	:	1245532894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIA JENICE MORRIS MSW, ACSW, LCSW

Provider Business Mailing Address
First Line	:	224 N HIGHWAY 67
Second Line	:	STE. #217
City	:	FLORISSANT
State	:	MO
Zip	:	63031-5904
Country	:	US
Telephone Number	:	314-323-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 N HIGHWAY 67
Second Line	:	STE. #217
City	:	FLORISSANT
State	:	MO
Zip	:	63031-5904
Country	:	US
Telephone Number	:	314-323-0463
Fax Number	:

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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