Provider Demographics
NPI:1760242911
Name:MORGAN, BRIAN (MA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11863 SW 180TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKER
Mailing Address - State:FL
Mailing Address - Zip Code:32622-3332
Mailing Address - Country:US
Mailing Address - Phone:217-972-4797
Mailing Address - Fax:
Practice Address - Street 1:11863 SW 180TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKER
Practice Address - State:FL
Practice Address - Zip Code:32622-3332
Practice Address - Country:US
Practice Address - Phone:217-972-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health