Provider Demographics
NPI:1730827411
Name:BOTTOMS, MORGAN ASHLEY
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:ASHLEY
Last Name:BOTTOMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 EVON WAY APT 4
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-7246
Mailing Address - Country:US
Mailing Address - Phone:270-586-1378
Mailing Address - Fax:
Practice Address - Street 1:1621 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3244
Practice Address - Country:US
Practice Address - Phone:270-842-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health