Provider Demographics
NPI:1144345109
Name:MORGAN, CLIFFORD O JR (PHD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:O
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:119 TELLES ST SW
Mailing Address - Street 2:P.O. BOC 1757
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8518
Mailing Address - Country:US
Mailing Address - Phone:505-865-7100
Mailing Address - Fax:505-865-7100
Practice Address - Street 1:119 TELLES ST SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8518
Practice Address - Country:US
Practice Address - Phone:505-865-7100
Practice Address - Fax:505-865-7100
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM174103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN6200Medicaid