Provider Demographics
NPI:1730502824
Name:MORGAN, JAY WILLIAM (LPE- I)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:WILLIAM
Last Name:MORGAN
Suffix:
Gender:M
Credentials:LPE- I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 NOTTINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-2397
Mailing Address - Country:US
Mailing Address - Phone:501-247-7111
Mailing Address - Fax:501-943-3016
Practice Address - Street 1:910 NOTTINGHAM CT
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2397
Practice Address - Country:US
Practice Address - Phone:501-247-7111
Practice Address - Fax:501-943-3016
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR87-06 LPE-1102L00000X
AR87-06EI103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis