Healthcare Provider Details

I. General information

NPI: 1477433456
Provider Name (Legal Business Name): KAMARIN MORGAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MERCURY DR
DEARBORN MI
48126-2947
US

IV. Provider business mailing address

18726 S WESTERN AVE
GARDENA CA
90248-3813
US

V. Phone/Fax

Practice location:
  • Phone: 313-612-5571
  • Fax:
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number25496259
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: