Provider Demographics
NPI:1740007483
Name:BEATTY-MORGAN, MYLES ALEXANDER (MA, TLLP)
Entity type:Individual
Prefix:
First Name:MYLES
Middle Name:ALEXANDER
Last Name:BEATTY-MORGAN
Suffix:
Gender:M
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:MYLES
Other - Middle Name:ALEXANDER
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, TLLP
Mailing Address - Street 1:28 RHODE ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3357
Mailing Address - Country:US
Mailing Address - Phone:313-282-3668
Mailing Address - Fax:
Practice Address - Street 1:28 RHODE ISLAND ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3357
Practice Address - Country:US
Practice Address - Phone:313-282-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362010025103TB0200X, 103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling