1982614798 NPI number — MR. MARK ALAN MORRISON LCSW

Table of content: MR. MARK ALAN MORRISON LCSW (NPI 1982614798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982614798 NPI number — MR. MARK ALAN MORRISON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRISON
Provider First Name:
MARK
Provider Middle Name:
ALAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982614798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1035 W GLEN OAKS LN STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEQUON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53092-3392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-244-6177
Provider Business Mailing Address Fax Number:
262-299-3040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11518 N PORT WASHINGTON RD STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEQUON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53092-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-962-7917
Provider Business Practice Location Address Fax Number:
262-299-3040
Provider Enumeration Date:
08/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4252123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 43742200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".