1972637494 NPI number — MORGAN & ASSOCIATES PSYCHSERVE, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972637494 NPI number — MORGAN & ASSOCIATES PSYCHSERVE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORGAN & ASSOCIATES PSYCHSERVE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972637494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 S OAK PARK AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60304-1224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-660-0776
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 S OAK PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60304-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-660-0776
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
STACY
Authorized Official Middle Name:
ANIECE
Authorized Official Title or Position:
PRESIDENT AND PSYCHOLOGIST
Authorized Official Telephone Number:
708-660-0776

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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