Basic Information
| Provider Information | |||||||||
| NPI: | 1639235815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | ALLYN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1643 EUREKA ROAD | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167717653 | ||||||||
| FaxNumber: | 9167717653 | ||||||||
| Practice Location | |||||||||
| Address1: | 1643 EUREKA RD | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956613027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167717653 | ||||||||
| FaxNumber: | 9167717650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS9587 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.