Individual
MORGAN PROVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13100 W LISBON RD STE 600, BROOKFIELD, WI 53005-2509
(833) 646-3222
(833) 646-3222
Mailing address
224 W 35TH ST STE 500, NEW YORK, NY 10001-2538
(833) 646-3222
(833) 646-3222
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
WI
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/10/2023
Last updated
09/22/2025
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