Basic Information
| Provider Information | |||||||||
| NPI: | 1679964928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORTON | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | DEPAUL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1843 R W BERENDS DR SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495194955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167732908 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1843 R W BERENDS DR SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495194955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167732908 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2015 | ||||||||
| LastUpdateDate: | 02/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401013315 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.