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General NPI Number Information
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NPI Number | 1285012823
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Entity Type | Individual
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Provider Name | JESSICA LYNN MORTON LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 299 COON RAPIDS BLVD NW STE 205
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City | COON RAPIDS
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State | MN
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Zip | 55433-5805
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Country | US
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Telephone | 763-290-6667
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Fax | 763-340-0730
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Provider Business Mailing Address
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Address Line | 299 COON RAPIDS BLVD NW STE 205
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City | COON RAPIDS
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State | MN
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Zip | 55433-5805
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Country | US
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Telephone | 763-290-6667
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Fax | 763-340-0730
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1191-124
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License Number State | WI
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