Provider Demographics
NPI:1720665813
Name:MORGAN, AMANDA ELLEN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELLEN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 HAMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-2302
Mailing Address - Country:US
Mailing Address - Phone:142-336-8709
Mailing Address - Fax:
Practice Address - Street 1:1510 STUART RD NE STE 119
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5876
Practice Address - Country:US
Practice Address - Phone:423-464-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician