Healthcare Provider Details

I. General information

NPI: 1811330087
Provider Name (Legal Business Name): MORGAN PAIGE BLACK M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 159TH ST BLDG C
OAK FOREST IL
60452-2904
US

IV. Provider business mailing address

3722 N SHEFFIELD AVE APT 1S
CHICAGO IL
60613-2964
US

V. Phone/Fax

Practice location:
  • Phone: 708-535-7320
  • Fax:
Mailing address:
  • Phone: 773-672-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.008843
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: