Basic Information
| Provider Information | |||||||||
| NPI: | 1811330087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLACK | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | PAIGE | ||||||||
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| Credential: | M.A., LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3722 N SHEFFIELD AVE | ||||||||
| Address2: | APT 1S | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606132964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736729640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6006 159TH ST | ||||||||
| Address2: | BLDG C | ||||||||
| City: | OAK FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604522904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085357320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2013 | ||||||||
| LastUpdateDate: | 05/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 178.008843 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.