Healthcare Provider Details

I. General information

NPI: 1952768442
Provider Name (Legal Business Name): ANGEL MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 08/03/2024
Certification Date: 08/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 W BROADWAY ST
MUSKOGEE OK
74401-6614
US

IV. Provider business mailing address

423 W BROADWAY ST
MUSKOGEE OK
74401-6614
US

V. Phone/Fax

Practice location:
  • Phone: 918-485-0242
  • Fax: 918-485-0204
Mailing address:
  • Phone: 918-485-0242
  • Fax: 918-485-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10661
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC05345
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: