Provider Demographics
NPI:1164524880
Name:MORGAN, CHAD YATES JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:YATES
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:YATES
Other - Last Name:MORGAN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:107 COUNTY ROAD 2308
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-6343
Mailing Address - Country:US
Mailing Address - Phone:903-832-2520
Mailing Address - Fax:
Practice Address - Street 1:1905 MALL DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2641
Practice Address - Country:US
Practice Address - Phone:903-792-8397
Practice Address - Fax:903-791-1925
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3134103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA81LOtherBCBS
AR96407OtherBCBS
TXA81LOtherBCBS