Provider Demographics
NPI:1154990018
Name:MORTON, MICHELLE (RMHCI)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MORTON
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7907 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-4944
Mailing Address - Country:US
Mailing Address - Phone:813-495-4177
Mailing Address - Fax:
Practice Address - Street 1:7907 RIVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-4944
Practice Address - Country:US
Practice Address - Phone:813-495-4177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000000Medicaid