Provider Demographics
NPI:1629239777
Name:MORGAN, M'LISSA RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:M'LISSA
Middle Name:RAE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 SW 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1604
Mailing Address - Country:US
Mailing Address - Phone:503-330-4607
Mailing Address - Fax:503-477-9651
Practice Address - Street 1:852 SW 21ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1604
Practice Address - Country:US
Practice Address - Phone:503-330-4607
Practice Address - Fax:503-477-9651
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL41611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical