1659850824 NPI number — JARET MICHAEL MORLAN LMSW

Table of content: JARET MICHAEL MORLAN LMSW (NPI 1659850824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659850824 NPI number — JARET MICHAEL MORLAN LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORLAN
Provider First Name:
JARET
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
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:
1659850824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 E AVE NW STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52405-2962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-531-4236
Provider Business Mailing Address Fax Number:
319-483-6661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 MARION BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52302-3135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-895-2704
Provider Business Practice Location Address Fax Number:
319-483-6661
Provider Enumeration Date:
08/09/2018

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: 104100000X , with the licence number:  091192 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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