Provider Demographics
NPI:1073575775
Name:MORGAN, CLARENCE D (PHD)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:D
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:C DON
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1010 N KANSAS
Mailing Address - Street 2:STE #3049
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3199
Mailing Address - Country:US
Mailing Address - Phone:316-293-2647
Mailing Address - Fax:316-293-1882
Practice Address - Street 1:7829 E ROCKHILL ST
Practice Address - Street 2:SUITE #105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3920
Practice Address - Country:US
Practice Address - Phone:316-293-3850
Practice Address - Fax:316-683-6733
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100239860AMedicaid
KS10940OtherBCBS
KS10940OtherBCBS
KS100239860AMedicaid