MEDICARE: MS. TERESA MORRIS LMFT

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	106H00000X	Marriage & Family Therapist	2181	MN

General Provider Information

NPI Number	:	1861861312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA MORRIS LMFT

Provider Business Mailing Address
First Line	:	948 COUNTY ROAD I W
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-1315
Country	:	US
Telephone Number	:	651-707-6415
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 COON RAPIDS BLVD NW STE 200
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-2753
Country	:	US
Telephone Number	:	763-784-3008
Fax Number	:

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

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/15/2015

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