Provider Demographics
NPI:1154626570
Name:MORGAN, MELANIE ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANNE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 S 77TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-1131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 BAY VIEW RD STE 4
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1750
Practice Address - Country:US
Practice Address - Phone:262-542-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-15
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3818-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1033127246OtherGROUP NPI
WI000-088574OtherGROUP MEDICARE (P-TAN)
WI42170300OtherGROUP MEDICAID