Provider Demographics
NPI:1447761481
Name:MORGAN, GRADY STEWART (LMFT)
Entity Type:Individual
Prefix:
First Name:GRADY
Middle Name:STEWART
Last Name:MORGAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N GALT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2309
Mailing Address - Country:US
Mailing Address - Phone:870-941-3116
Mailing Address - Fax:
Practice Address - Street 1:503 WASHBURN AVE STE 203
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4798
Practice Address - Country:US
Practice Address - Phone:502-509-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174865106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist