MEDICARE: WILLIAM MORRIS BCBA

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	106S00000X	Behavior Technician	18-73216
2	103K00000X	Behavior Analyst	1-21-50104

General Provider Information

NPI Number	:	1659994929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MORRIS BCBA

Provider Business Mailing Address
First Line	:	6228 FILBERT AVE STE 3
Second Line	:
City	:	ORANGEVALE
State	:	CA
Zip	:	95662-4106
Country	:	US
Telephone Number	:	916-239-9589
Fax Number	:

Provider Business Practice Location Address
First Line	:	922 57TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3328
Country	:	US
Telephone Number	:	916-228-4169
Fax Number	:

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

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	06/14/2021

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