Provider Demographics
NPI:1922282003
Name:MORGAN, GWENNETH TAYLOR (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:GWENNETH
Middle Name:TAYLOR
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:502 E. SAN PATRICIO AVE
Practice Address - Street 2:
Practice Address - City:MATHIS
Practice Address - State:TX
Practice Address - Zip Code:78368-7836
Practice Address - Country:US
Practice Address - Phone:361-547-4121
Practice Address - Fax:361-384-4254
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144983711Medicaid
TX144983703Medicaid
TX741679824OtherTAX ID NUMBER FOR COMMUNITY ACTION CORPORATION OF SOUTH TEXAS