Provider Demographics
NPI:1467981902
Name:MMORTONLLC
Entity Type:Organization
Organization Name:MMORTONLLC
Other - Org Name:MICHAEL A MORTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL A
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:505-270-2547
Mailing Address - Street 1:480 ZUNI RIVER CIR SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8690
Mailing Address - Country:US
Mailing Address - Phone:505-270-2547
Mailing Address - Fax:
Practice Address - Street 1:480 ZUNI RIVER CIR SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8690
Practice Address - Country:US
Practice Address - Phone:505-270-2547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0173671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM017361OtherLMFT