Provider Demographics
NPI:1285012823
Name:MORTON, JESSICA LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:MORTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 COON RAPIDS BLVD NW STE 205
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5805
Mailing Address - Country:US
Mailing Address - Phone:763-290-6667
Mailing Address - Fax:763-340-0730
Practice Address - Street 1:299 COON RAPIDS BLVD NW STE 205
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5805
Practice Address - Country:US
Practice Address - Phone:763-290-6667
Practice Address - Fax:763-340-0730
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1191-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist