Provider Demographics
NPI:1932862562
Name:MORGAN, CHARLES TY (LISW-S)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:TY
Last Name:MORGAN
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4453 LOCKMOOR LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-6805
Mailing Address - Country:US
Mailing Address - Phone:513-519-1905
Mailing Address - Fax:
Practice Address - Street 1:1839 PEARL RD STE 101
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3256
Practice Address - Country:US
Practice Address - Phone:330-220-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical