Healthcare Provider Details

I. General information

NPI: 1659452654
Provider Name (Legal Business Name): KELLY ELIZABETH MORGAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 SOUTH STATE STREET STE. 100
MADISONVILLE TX
77864
US

IV. Provider business mailing address

PO BOX 538
MADISONVILLE TX
77864-0538
US

V. Phone/Fax

Practice location:
  • Phone: 936-348-3516
  • Fax: 936-348-3163
Mailing address:
  • Phone: 936-348-3516
  • Fax: 936-348-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16178
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: