Healthcare Provider Details

I. General information

NPI: 1306579776
Provider Name (Legal Business Name): MORGAN HALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 KINGSLEY LAKE DR STE 702
SAINT AUGUSTINE FL
32092-3045
US

IV. Provider business mailing address

311 RIVER MIST DR
SAINT AUGUSTINE FL
32095-9047
US

V. Phone/Fax

Practice location:
  • Phone: 904-419-8531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberISW13215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: