Provider Demographics
NPI:1871006692
Name:MORRIS, JACQUELINE J (MASTERS)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:MORRIS
Suffix:
Gender:
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 W 35TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-3927
Mailing Address - Country:US
Mailing Address - Phone:323-674-9049
Mailing Address - Fax:
Practice Address - Street 1:1654 W 35TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-3927
Practice Address - Country:US
Practice Address - Phone:323-674-9049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152918106H00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)