Healthcare Provider Details

I. General information

NPI: 1679219430
Provider Name (Legal Business Name): MORGAN LEE STONE IADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 S HIGH AVE
AMES IA
50010-8055
US

IV. Provider business mailing address

1619 S HIGH AVE
AMES IA
50010-8055
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-5811
  • Fax:
Mailing address:
  • Phone: 515-232-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22001
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: