MEDICARE: RONALD MORRIS 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720776743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD MORRIS LLC

Provider Business Mailing Address
First Line	:	8916 EGYPTIAN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-1172
Country	:	US
Telephone Number	:	215-651-5654
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 E BONNEVILLE AVE STE 105C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6622
Country	:	US
Telephone Number	:	215-651-5654
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RONALD D FAGGINS
Credential	:	LPC
Telephone Number	:	215-651-5654

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	01/29/2026

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