Provider Demographics
NPI:1942387741
Name:MORGAN, TINA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:M
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1736 E SUNSHINE ST STE 709
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1342
Mailing Address - Country:US
Mailing Address - Phone:417-830-2743
Mailing Address - Fax:417-350-1938
Practice Address - Street 1:1736 E SUNSHINE ST STE 709
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1342
Practice Address - Country:US
Practice Address - Phone:417-830-2743
Practice Address - Fax:417-350-1938
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO01905103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493299358Medicaid
MO1698615OtherBCBS
MO431366579GUNOtherPREMIER