Provider Demographics
NPI:1154070803
Name:MORTON, SIDNEY C (LAC)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:C
Last Name:MORTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 S 53RD ST APT 403
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-6187
Mailing Address - Country:US
Mailing Address - Phone:479-295-8461
Mailing Address - Fax:
Practice Address - Street 1:4654 S 53RD ST APT 403
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-6187
Practice Address - Country:US
Practice Address - Phone:479-295-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2408009101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional