Provider Demographics
NPI:1770719957
Name:MORSE, MAX (EDD)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:
Last Name:MORSE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 MOUNT RUSHMORE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8200
Mailing Address - Country:US
Mailing Address - Phone:605-216-8859
Mailing Address - Fax:605-388-8003
Practice Address - Street 1:1107 MOUNT RUSHMORE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8200
Practice Address - Country:US
Practice Address - Phone:605-216-8859
Practice Address - Fax:605-388-8003
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2179101YP2500X
WYLPC1014101YP2500X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst