MEDICARE: SAMANTHA MARIE MORRIS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1255100202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MARIE MORRIS

Provider Business Mailing Address
First Line	:	4705 MATHEWS AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-4247
Country	:	US
Telephone Number	:	615-640-5310
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 MATHEWS AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-4247
Country	:	US
Telephone Number	:	615-640-5310
Fax Number	:

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

Provider Enumeration Date	:	01/01/2024
Last Update Date	:	01/01/2024

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