MEDICARE: SYDNEY KATHERINE MORRISON 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	103K00000X	Behavior Analyst	1-17-28453	TX

General Provider Information

NPI Number	:	1891201935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY KATHERINE MORRISON BCBA

Provider Business Mailing Address
First Line	:	408 VERNA TRL N
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4301
Country	:	US
Telephone Number	:	817-925-4890
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 SUMMIT AVE STE 880
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4429
Country	:	US
Telephone Number	:	469-831-5509
Fax Number	:

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

Provider Enumeration Date	:	12/27/2017
Last Update Date	:	12/27/2017

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