NPIMap

Individual provider Active NPI

Morgan Celeste Black

  • Counselor
  • Olympia, WA
National Provider Identifier
1366972069
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
612 Woodland Square Loop SE Ste 401
Olympia, WA 98503
Phone
(360) 999-9053
NPI assigned
Jun 14, 2017
Last updated
Jan 25, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary
Mental Health Counselor 101YM0800X CG60190853 WA

Addresses

Primary practice location

612 Woodland Square Loop SE Ste 401
Olympia, WA 98503

Mailing address

612 Woodland Square Loop SE Ste 401
Olympia, WA 98503-1070
Phone (360) 999-9053

Other practice location 1

3491 Ferguson St SW
Tumwater, WA 98512-6127
Phone (360) 709-5918

Other identifiers 1

IdentifierTypeStateIssuer
1366972069MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CG60190853WAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Thurston Mason Behavioral Health Organization Past Accepting new patients
Olympic Health and Recovery Services PastSince Jun 14, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548374400000",
    "number": "1366972069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 WOODLAND SQUARE LOOP SE STE 401",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985031070",
            "telephone_number": "360-999-9053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 WOODLAND SQUARE LOOP SE STE 401",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "98503",
            "telephone_number": "360-999-9053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3491 Ferguson St SW",
            "address_purpose": "LOCATION",
            "city": "Tumwater",
            "state": "WA",
            "postal_code": "985126127",
            "country_code": "US",
            "telephone_number": "360-709-5918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MORGAN",
        "middle_name": "CELESTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-14",
        "last_updated": "2019-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "CG60190853",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366972069",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.