Healthcare Provider Details

I. General information

NPI: 1811754302
Provider Name (Legal Business Name): MORGAN ASHLEY MCDANIEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 N ILLINOIS ST STE D
SWANSEA IL
62226-1967
US

IV. Provider business mailing address

4 NOLES DR
FAIRVIEW HEIGHTS IL
62208-1628
US

V. Phone/Fax

Practice location:
  • Phone: 618-520-1764
  • Fax: 618-825-9400
Mailing address:
  • Phone: 618-409-6248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.019463
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: