Provider Demographics
NPI:1609685296
Name:PETERSON, MORGAN (LLMFT)
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3203
Mailing Address - Country:US
Mailing Address - Phone:219-241-0451
Mailing Address - Fax:
Practice Address - Street 1:1108 ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5470
Practice Address - Country:US
Practice Address - Phone:616-229-9244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151001160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist