Provider Demographics
NPI:1275158974
Name:MORGAN, MAGNUM (AMFT)
Entity Type:Individual
Prefix:
First Name:MAGNUM
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 S 250 W STE 208
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6747
Mailing Address - Country:US
Mailing Address - Phone:435-688-1111
Mailing Address - Fax:435-688-8488
Practice Address - Street 1:1760 N MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7807
Practice Address - Country:US
Practice Address - Phone:435-688-1111
Practice Address - Fax:435-688-8488
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9640257-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist