Healthcare Provider Details

I. General information

NPI: 1063021574
Provider Name (Legal Business Name): CRYSTAL M MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14677 MERRILL AVE
FONTANA CA
92335-4219
US

IV. Provider business mailing address

12078 CLARK ST APT 106
MORENO VALLEY CA
92557-8663
US

V. Phone/Fax

Practice location:
  • Phone: 951-643-2335
  • Fax:
Mailing address:
  • Phone: 951-525-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number86113
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number86113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: