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General NPI Number Information
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NPI Number | 1225812712
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Entity Type | Individual
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Provider Name | MORGAN LOUISE NIETO
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Gender | Female
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 2460 BURTON ST SE STE 101
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-4800
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Country | US
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Telephone | 616-309-0737
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Fax |
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Provider Business Mailing Address
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Address Line | 57703 CIDER MILL DR
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City | NEW HUDSON
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State | MI
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Zip | 48165-9481
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Country | US
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Telephone | 248-880-2684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6451023377
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License Number State | MI
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