Provider Demographics
NPI:1831298322
Name:MORGAN, MORGAN DODD (MA)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:DODD
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2793
Mailing Address - Country:US
Mailing Address - Phone:304-472-7778
Mailing Address - Fax:304-472-7779
Practice Address - Street 1:102 E MAIN ST APT 2
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2793
Practice Address - Country:US
Practice Address - Phone:304-472-7778
Practice Address - Fax:304-472-7779
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV879103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000215Medicaid