1184642688 NPI number — DR. JOHN SOMERS MORRELL PHD

Table of content: DR. JOHN SOMERS MORRELL PHD (NPI 1184642688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184642688 NPI number — DR. JOHN SOMERS MORRELL PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRELL
Provider First Name:
JOHN
Provider Middle Name:
SOMERS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1184642688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 N PORT WASHINGTON RD
Provider Second Line Business Mailing Address:
SUITE 230 HEALTH PSYCHOLOGY ASSOCIATES
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-962-4048
Provider Business Mailing Address Fax Number:
414-962-4052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5007 S HOWELL AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53207-6158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-789-1191
Provider Business Practice Location Address Fax Number:
414-962-4052
Provider Enumeration Date:
07/17/2006

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: 103T00000X , with the licence number:  2230057 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39131100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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