Provider Demographics
NPI:1871586230
Name:MORRIS, KENNETH (MS PA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MS PA
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS PA
Mailing Address - Street 1:2689 CHAPMAN DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4918
Mailing Address - Country:US
Mailing Address - Phone:850-215-3088
Mailing Address - Fax:850-215-3188
Practice Address - Street 1:2689 CHAPMAN DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4918
Practice Address - Country:US
Practice Address - Phone:850-215-3088
Practice Address - Fax:850-215-3188
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1298106H00000X
FLMH1967101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health