Provider Demographics
NPI:1457993230
Name:MORGAN MENTAL HEALTH GROUP LLC
Entity Type:Organization
Organization Name:MORGAN MENTAL HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-890-7165
Mailing Address - Street 1:4600 W QUARTERHORSE LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5438
Mailing Address - Country:US
Mailing Address - Phone:208-890-7165
Mailing Address - Fax:
Practice Address - Street 1:4600 W QUARTERHORSE LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5438
Practice Address - Country:US
Practice Address - Phone:208-890-7165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMI MORGAN THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty