Healthcare Provider Details

I. General information

NPI: 1558607614
Provider Name (Legal Business Name): CAROLYN MORGAN MN, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 LLANO ST STE. C
SANTA FE NM
87505-2000
US

IV. Provider business mailing address

PO BOX 793
EL PRADO NM
87529-0793
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-5765
  • Fax:
Mailing address:
  • Phone: 575-770-5765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3490
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: