Healthcare Provider Details

I. General information

NPI: 1013629187
Provider Name (Legal Business Name): CRYSTAL JEAN MORGAN QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 E 55TH ST
CLEVELAND OH
44103-3602
US

IV. Provider business mailing address

18502 MAPLE HEIGHTS BLVD
MAPLE HEIGHTS OH
44137-2760
US

V. Phone/Fax

Practice location:
  • Phone: 216-417-4213
  • Fax:
Mailing address:
  • Phone: 216-632-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: