1659714855 NPI number — MRS. MORGAN ALISE HINTON M.S. PSYCHOLOGY / CH

Table of content: MRS. MORGAN ALISE HINTON M.S. PSYCHOLOGY / CH (NPI 1659714855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659714855 NPI number — MRS. MORGAN ALISE HINTON M.S. PSYCHOLOGY / CH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINTON
Provider First Name:
MORGAN
Provider Middle Name:
ALISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. PSYCHOLOGY / CH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANDRUM
Provider Other First Name:
MORGAN
Provider Other Middle Name:
ALISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S. PSYCHOLOGY / CH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1659714855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3407 SHAMROCK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAUTIER
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39553-5337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3407 SHAMROCK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAUTIER
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39553-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-497-0690
Provider Business Practice Location Address Fax Number:
228-497-1363
Provider Enumeration Date:
04/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00018214 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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