Provider Demographics
NPI:1588200760
Name:KELLY MORSE COUNSELING, LLC
Entity Type:Organization
Organization Name:KELLY MORSE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-815-3959
Mailing Address - Street 1:1092 E 255 S
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4496
Mailing Address - Country:US
Mailing Address - Phone:801-815-3959
Mailing Address - Fax:
Practice Address - Street 1:1092 E 255 S
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4496
Practice Address - Country:US
Practice Address - Phone:801-815-3959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1871774596Medicaid