MEDICARE: TANYA M MORREL PHD LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	03705	MD

General Provider Information

NPI Number	:	1285941476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANYA M MORREL PHD LLC

Provider Business Mailing Address
First Line	:	5301 FALLS ROAD TER
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21210-1905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 BOSLEY AVE
Second Line	:	SUITE A5
City	:	BALTIMORE
State	:	MD
Zip	:	21204-4328
Country	:	US
Telephone Number	:	410-832-0113
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. TANYA MORAN MORREL
Credential	:	PH.D.
Telephone Number	:	410-832-0113

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	09/09/2010

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