Healthcare Provider Details

I. General information

NPI: 1124601539
Provider Name (Legal Business Name): MARY MORGAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 BIELBY RD
LAWRENCEBURG IN
47025-1002
US

IV. Provider business mailing address

19070 EDINBURGH DR
SOUTH BEND IN
46614-5804
US

V. Phone/Fax

Practice location:
  • Phone: 812-727-2019
  • Fax:
Mailing address:
  • Phone: 574-360-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number39001439A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: