Individual
MORGAN PROVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT, MS
Contact information
Practice address
1655 W MEQUON RD, MEQUON, WI 53092-3254
(414) 292-4242
(262) 240-9745
Mailing address
4041 N OAKLAND AVE APT 304, SHOREWOOD, WI 53211-2386
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
WI
101YP2500X
Professional Counselor
Primary
9124-226
WI
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/10/2023
Last updated
06/26/2026
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