1730402660 NPI number — LAUREL BALYEAT MORRISON M.A.,MARR & FAM.THER

Table of content: LAUREL BALYEAT MORRISON M.A.,MARR & FAM.THER (NPI 1730402660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730402660 NPI number — LAUREL BALYEAT MORRISON M.A.,MARR & FAM.THER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRISON
Provider First Name:
LAUREL
Provider Middle Name:
BALYEAT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.,MARR & FAM.THER
Provider Gender Code:
F

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:
1730402660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6049 FELIX AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94805-1218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-323-4737
Provider Business Mailing Address Fax Number:
510-323-4737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3118 SHANE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94806-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-323-4737
Provider Business Practice Location Address Fax Number:
510-323-4737
Provider Enumeration Date:
03/06/2010

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: 106H00000X , with the licence number:  MFT17966 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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