Provider Demographics
NPI:1518067008
Name:MORGAN, GARY ALAN (LCSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
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 1:2087 N STATE ROAD 67
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-6827
Mailing Address - Country:US
Mailing Address - Phone:812-886-4899
Mailing Address - Fax:812-886-4884
Practice Address - Street 1:2087 N STATE ROAD 67
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-6827
Practice Address - Country:US
Practice Address - Phone:812-886-4899
Practice Address - Fax:812-886-4884
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002196A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34002196AOtherLICENSE NUMBER
IN34002196AOtherLICENSE NUMBER