Healthcare Provider Details

I. General information

NPI: 1649133380
Provider Name (Legal Business Name): JASON MORGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 COUNTY ROAD B W STE 312
ROSEVILLE MN
55113-4107
US

IV. Provider business mailing address

1611 COUNTY ROAD B W STE 312
ROSEVILLE MN
55113-4107
US

V. Phone/Fax

Practice location:
  • Phone: 651-243-0077
  • Fax: 651-273-2201
Mailing address:
  • Phone: 651-243-0077
  • Fax: 651-273-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3235
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: