Provider Demographics
NPI:1538799291
Name:MORRELL, PAUL BRADLEY (MA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BRADLEY
Last Name:MORRELL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2028
Mailing Address - Country:US
Mailing Address - Phone:423-914-9830
Mailing Address - Fax:
Practice Address - Street 1:4006 FORT HENRY DR STE 1
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2028
Practice Address - Country:US
Practice Address - Phone:423-914-9830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health