1851754493 NPI number — MRS. DAPHNE MORRISON L.I.C.S.W

Table of content: GABRIELLE JERISE EZELL MD, MS (NPI 1396549556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851754493 NPI number — MRS. DAPHNE MORRISON L.I.C.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRISON
Provider First Name:
DAPHNE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.I.C.S.W
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EATON
Provider Other First Name:
DAPHNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851754493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1313 NE 134TH ST
Provider Second Line Business Mailing Address:
SUITE 220A
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98685-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-737-9792
Provider Business Mailing Address Fax Number:
360-737-6663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 NE 134TH ST
Provider Second Line Business Practice Location Address:
SUITE 220A
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98685-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-737-9792
Provider Business Practice Location Address Fax Number:
360-737-6663
Provider Enumeration Date:
03/31/2016

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:  LW60431540 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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