Healthcare Provider Details

I. General information

NPI: 1568965101
Provider Name (Legal Business Name): MICHELLE MORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 14TH ST
MODESTO CA
95354-1003
US

IV. Provider business mailing address

426 LOCUST ST
MODESTO CA
95351-2699
US

V. Phone/Fax

Practice location:
  • Phone: 209-572-2589
  • Fax: 209-572-2589
Mailing address:
  • Phone: 209-574-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-81731
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: