Provider Demographics
NPI:1841682416
Name:MORGAN, BETHANN (MA, MED, CAGS)
Entity type:Individual
Prefix:
First Name:BETHANN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MA, MED, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8045
Mailing Address - Country:US
Mailing Address - Phone:740-653-3193
Mailing Address - Fax:
Practice Address - Street 1:955 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8045
Practice Address - Country:US
Practice Address - Phone:740-653-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOS1041754103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool