Healthcare Provider Details

I. General information

NPI: 1801385570
Provider Name (Legal Business Name): MORGAN NICOLLE CLEVIDENCE LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FORT THOMAS AVE
FORT THOMAS KY
41075-2305
US

IV. Provider business mailing address

1000 S FORT THOMAS AVE
FORT THOMAS KY
41075-2305
US

V. Phone/Fax

Practice location:
  • Phone: 859-572-6781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2102247
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162711
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: