Provider Demographics
NPI:1639553803
Name:MORGAN, WESLEY (LPC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 LAKE EASTBROOK BLVD SE STE 258
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5938
Mailing Address - Country:US
Mailing Address - Phone:616-719-0194
Mailing Address - Fax:800-219-5205
Practice Address - Street 1:1971 E BELTLINE AVE NE STE 200H
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7045
Practice Address - Country:US
Practice Address - Phone:616-219-8539
Practice Address - Fax:616-259-6936
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013462101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor