Provider Demographics
NPI:1861540361
Name:MORGAN, MICKEY J (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICKEY
Middle Name:J
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14425 MASON LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2662
Mailing Address - Country:US
Mailing Address - Phone:708-460-5209
Mailing Address - Fax:708-460-6327
Practice Address - Street 1:14425 MASON LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2662
Practice Address - Country:US
Practice Address - Phone:708-460-5209
Practice Address - Fax:708-460-6327
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627063OtherBLUE CROSS BLUE SHIELD ID