Provider Demographics
NPI:1417049065
Name:MORGAN, KENNETH S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:S
Last Name:MORGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3884 ORCHARD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83406
Mailing Address - Country:US
Mailing Address - Phone:208-522-1154
Mailing Address - Fax:
Practice Address - Street 1:2235 E 25TH ST STE 290
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7595
Practice Address - Country:US
Practice Address - Phone:208-552-0490
Practice Address - Fax:208-552-2518
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-25228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000410152046OtherREGENCE BLUE SHEILD OF ID
IDL5063OtherBLUE CROSS