Provider Demographics
NPI:1386230035
Name:LITTICH, MORGAN AUTUMN (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:MORGAN
Middle Name:AUTUMN
Last Name:LITTICH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-8519
Mailing Address - Country:US
Mailing Address - Phone:601-863-6098
Mailing Address - Fax:
Practice Address - Street 1:140 THORNTON RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-8519
Practice Address - Country:US
Practice Address - Phone:601-863-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS86084241133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered