MEDICARE: WESLEY MORGAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	6401013462	MI

General Provider Information

NPI Number	:	1639553803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY MORGAN LPC

Provider Business Mailing Address
First Line	:	2050 BRETON RD SE STE 104
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-5547
Country	:	US
Telephone Number	:	616-219-8539
Fax Number	:	616-259-6936

Provider Business Practice Location Address
First Line	:	2050 BRETON RD SE STE 104
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-5547
Country	:	US
Telephone Number	:	616-219-8539
Fax Number	:	616-259-6936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	03/28/2025

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