Provider Demographics
NPI:1396369955
Name:MORGAN, ALICIA L (EDS)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:MORGAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66872-0322
Mailing Address - Country:US
Mailing Address - Phone:785-493-2505
Mailing Address - Fax:
Practice Address - Street 1:119 S ELM ST
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:KS
Practice Address - Zip Code:66872-9201
Practice Address - Country:US
Practice Address - Phone:785-493-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9552778212103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSK01649934Medicaid