1528445079 NPI number — MR. TERRY JOHN MORRILL B.A. PSYCHOLOGY

Table of content: MR. TERRY JOHN MORRILL B.A. PSYCHOLOGY (NPI 1528445079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528445079 NPI number — MR. TERRY JOHN MORRILL B.A. PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRILL
Provider First Name:
TERRY
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
B.A. PSYCHOLOGY
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:
1528445079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1642
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82931-1642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-789-0664
Provider Business Mailing Address Fax Number:
307-222-0614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 S BROADWAY AVE
Provider Second Line Business Practice Location Address:
202
Provider Business Practice Location Address City Name:
RIVERTON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82501-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-856-6991
Provider Business Practice Location Address Fax Number:
307-222-0614
Provider Enumeration Date:
05/05/2015

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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