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NPI Code Detail

MEDICARE: JAMES B MORRISSEY EDD

MEDICARE: JAMES B MORRISSEY EDD
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
1103T00000XPsychologist6301004080MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1680B84512OTHERMIBLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number : 1316962392
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES B MORRISSEY EDD
Provider Business Mailing Address
First Line : PO BOX 45
Second Line : PORTAGE
City : PORTAGE
State : IN
Zip : 46368-0045
Country : US
Telephone Number : 219-787-1510
Fax Number : 219-787-8761
Provider Business Practice Location Address
First Line : 4020 COPPER VIEW DR
Second Line : TRAVERSE CITY
City : TRAVERSE CITY
State : MI
Zip : 49684-1364
Country : US
Telephone Number : 231-947-0795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 07/02/2008

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