Provider Demographics
NPI:1770105793
Name:MORGAN, EMILY MIRRIAM III
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MIRRIAM
Last Name:MORGAN
Suffix:III
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 1:901 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-7163
Mailing Address - Country:US
Mailing Address - Phone:573-872-0665
Mailing Address - Fax:
Practice Address - Street 1:1013 WINNIE ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-6457
Practice Address - Country:US
Practice Address - Phone:573-872-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty