Provider Demographics
NPI:1093477648
Name:MORGAN, DOROTHY A (LAC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16774 W FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-6154
Mailing Address - Country:US
Mailing Address - Phone:623-418-5084
Mailing Address - Fax:
Practice Address - Street 1:16774 W FILLMORE ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-6154
Practice Address - Country:US
Practice Address - Phone:623-418-5084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103641101YM0800X
AZ3726011101YS0200X
AZLAC-21749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool