Healthcare Provider Details

I. General information

NPI: 1215536289
Provider Name (Legal Business Name): CRYSTAL MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MAIN ST STE 109
AUBURN ME
04210-5811
US

IV. Provider business mailing address

925 MAIN ST
MONMOUTH ME
04259-7027
US

V. Phone/Fax

Practice location:
  • Phone: 207-577-9095
  • Fax:
Mailing address:
  • Phone: 207-577-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC6825
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberXL4728
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: