Provider Demographics
NPI:1669160438
Name:TWIN PORTS PSYCHOLOGY LLC
Entity type:Organization
Organization Name:TWIN PORTS PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:218-451-2497
Mailing Address - Street 1:23 W CENTRAL ENTRANCE # 426
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3433
Mailing Address - Country:US
Mailing Address - Phone:218-451-2497
Mailing Address - Fax:
Practice Address - Street 1:130 W SUPERIOR ST STE 630
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-4030
Practice Address - Country:US
Practice Address - Phone:218-451-2497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty