Provider Demographics
NPI:1104336148
Name:MORGAN, KATELYN MARY (MS)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARY
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 SUMMER WINDS CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6341
Mailing Address - Country:US
Mailing Address - Phone:407-709-1579
Mailing Address - Fax:
Practice Address - Street 1:2923 SUMMER WINDS CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6341
Practice Address - Country:US
Practice Address - Phone:407-785-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMHC16332101YM0800X
FL16332101YM0800X
FL1241254101YS0200X
FL20534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113754700Medicaid