Basic Information
| Provider Information | |||||||||
| NPI: | 1750995163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | DAREISHIA | ||||||||
| MiddleName: | EMMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2235 LAKE AVE STE 211 | ||||||||
| Address2: | |||||||||
| City: | ALTADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910012491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267979196 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2750 E WASHINGTON BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911071449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262968900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2020 | ||||||||
| LastUpdateDate: | 09/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | CA | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 171M00000X | CA | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.