Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | PCOP880 | AK |
NPI | 1003218538 |
---|---|
Provider Name | Mrs. Jennifer L Morton |
First Address | Nome, AK 99762-0893 |
Second Address | Nome, AK 99762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2014 |
Last Update Date | 02/11/2021 |