Provider Demographics
NPI:1063849164
Name:PETERSON, MORGAN MARIE (QMHP, MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:MARIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:QMHP, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 W SHAMROCK LN UNIT C
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8700
Mailing Address - Country:US
Mailing Address - Phone:815-344-9443
Mailing Address - Fax:
Practice Address - Street 1:4209 W SHAMROCK LN UNIT C
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8700
Practice Address - Country:US
Practice Address - Phone:815-344-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL1490267841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health