Healthcare Provider Details

I. General information

NPI: 1134546484
Provider Name (Legal Business Name): MORGAN TAYLOR MAXWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WARREN AVE
GILLETTE WY
82716-3728
US

IV. Provider business mailing address

100 WARREN AVE
GILLETTE WY
82716-3728
US

V. Phone/Fax

Practice location:
  • Phone: 307-387-0454
  • Fax:
Mailing address:
  • Phone: 307-387-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2562
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: