Provider Demographics
NPI:1942750138
Name:MORTON, AUDREY (LPC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:MORTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 JUNGERMANN RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6967
Mailing Address - Country:US
Mailing Address - Phone:636-498-0700
Mailing Address - Fax:636-498-0050
Practice Address - Street 1:1286 JUNGERMANN RD
Practice Address - Street 2:SUITE G
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6967
Practice Address - Country:US
Practice Address - Phone:636-498-0700
Practice Address - Fax:636-498-0050
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012031016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional