Healthcare Provider Details

I. General information

NPI: 1205989449
Provider Name (Legal Business Name): NANCY A MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N. MARKET ST. SUITE 102
WAILUKU HI
96793
US

IV. Provider business mailing address

105 N. MARKET ST. SUITE 102
WAILUKU HI
96793
US

V. Phone/Fax

Practice location:
  • Phone: 509-241-7349
  • Fax: 509-241-7628
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00020863
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMHC-555
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: