MEDICARE: MICHAEL ROY MORRIS MS, LPCC

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	101YP2500X	Professional Counselor	CC00805	MN

General Provider Information

NPI Number	:	1831645886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROY MORRIS MS, LPCC

Provider Business Mailing Address
First Line	:	5985 RICE CREEK PKWY STE 201
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-5037
Country	:	US
Telephone Number	:	651-348-7240
Fax Number	:	651-348-7265

Provider Business Practice Location Address
First Line	:	5985 RICE CREEK PKWY STE 201
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-5037
Country	:	US
Telephone Number	:	651-348-7240
Fax Number	:	651-348-7265

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

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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