Provider Demographics
NPI:1215373378
Name:FREDERICK, MORGAN LEE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LEE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:LEE
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:68 EXETER RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1829
Practice Address - Country:US
Practice Address - Phone:731-201-1486
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TN1584103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst