Healthcare Provider Details

I. General information

NPI: 1174993349
Provider Name (Legal Business Name): MICHELLE LISA MORTON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 GULTON CT NE STE A
ALBUQUERQUE NM
87109-4407
US

IV. Provider business mailing address

6612 GULTON CT NE STE A
ALBUQUERQUE NM
87109-4407
US

V. Phone/Fax

Practice location:
  • Phone: 505-221-6045
  • Fax:
Mailing address:
  • Phone: 505-221-6045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0222731
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0176731
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: