Healthcare Provider Details

I. General information

NPI: 1659942134
Provider Name (Legal Business Name): AUSTIN CHANCE MORGAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTHALL LN STE 135
MAITLAND FL
32751-4195
US

IV. Provider business mailing address

8338 TUCKAHOE CT
ORLANDO FL
32829-8545
US

V. Phone/Fax

Practice location:
  • Phone: 407-534-0186
  • Fax:
Mailing address:
  • Phone: 407-202-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW18366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: