Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | ||
Y | 103TF0200X | Forensic Psychologist |
NPI | 1083111934 |
---|---|
Provider Name | Elijah Paul Morrow |
First Address | Pasadena, CA 91105-4514 |
Second Address | Richmond, CA 94806-5848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2018 |
Last Update Date | 08/04/2018 |