Provider Demographics
NPI:1811330087
Name:BLACK, MORGAN PAIGE (MA, LPC)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:PAIGE
Last Name:BLACK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 N SHEFFIELD AVE
Mailing Address - Street 2:APT 1S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2964
Mailing Address - Country:US
Mailing Address - Phone:773-672-9640
Mailing Address - Fax:
Practice Address - Street 1:6006 159TH ST
Practice Address - Street 2:BLDG C
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2904
Practice Address - Country:US
Practice Address - Phone:708-535-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional