Healthcare Provider Details

I. General information

NPI: 1508916172
Provider Name (Legal Business Name): NANCY LORENE MORGRIDGE MA LPC NCC CCJP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 ELKVIEW DR SUITE 3
GAYLORD MI
49735-2055
US

IV. Provider business mailing address

1165 ELKVIEW DR SUITE 3
GAYLORD MI
49735-2055
US

V. Phone/Fax

Practice location:
  • Phone: 989-732-6761
  • Fax: 989-732-6763
Mailing address:
  • Phone: 989-732-6761
  • Fax: 989-732-6763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: