Provider Demographics
NPI:1831212216
Name:MORGAN, MARIAN F (LCSW EDS)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:F
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LCSW EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2267 TETON PLZ
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6486
Mailing Address - Country:US
Mailing Address - Phone:208-542-4405
Mailing Address - Fax:208-542-6272
Practice Address - Street 1:2267 TETON PLZ
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6486
Practice Address - Country:US
Practice Address - Phone:208-542-4405
Practice Address - Fax:208-542-6272
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-24101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor