Provider Demographics
NPI:1881226827
Name:MACK, MORGAN MCCALL (LAMFT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:MCCALL
Last Name:MACK
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20328 E CLOUD RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5426
Mailing Address - Country:US
Mailing Address - Phone:480-734-7804
Mailing Address - Fax:
Practice Address - Street 1:2200 E WILLIAMS FIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0764
Practice Address - Country:US
Practice Address - Phone:623-900-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-6348T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ47274255OtherPRIVATE PRACTICE