Provider Demographics
NPI:1922857333
Name:MORRIS, MISS KAWANNA (CPSW CYPSS)
Entity type:Individual
Prefix:
First Name:MISS
Middle Name:KAWANNA
Last Name:MORRIS
Suffix:
Gender:F
Credentials:CPSW CYPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 DIAMOND MESA TRL SW APT 4209
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-3731
Mailing Address - Country:US
Mailing Address - Phone:505-441-0995
Mailing Address - Fax:
Practice Address - Street 1:300 CENTRAL AVE SW STE 1500
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3298
Practice Address - Country:US
Practice Address - Phone:505-441-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1726171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator