Provider Demographics
NPI:1033628532
Name:MOUMOURIS, MORGAN FUTCH (NCC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:FUTCH
Last Name:MOUMOURIS
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:DIANE
Other - Last Name:FUTCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8006 BRIGHTON SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1559
Mailing Address - Country:US
Mailing Address - Phone:352-455-9606
Mailing Address - Fax:
Practice Address - Street 1:911 N BUFFALO DR UNIT 213
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0381
Practice Address - Country:US
Practice Address - Phone:702-405-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI0329101Y00000X
251S00000X
NVCP1272101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty