Provider Demographics
NPI:1669018321
Name:GAEKE, MORGAN ANTONETTE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:ANTONETTE
Last Name:GAEKE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:A
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, PLMFT
Mailing Address - Street 1:1611 S BALTIMORE ST STE A
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 S BALTIMORE ST STE A
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4519
Practice Address - Country:US
Practice Address - Phone:660-665-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019030798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist