Provider Demographics
NPI:1215743968
Name:BOTTOMLEY, MORGAN (LCSW, CSAYC)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BOTTOMLEY
Suffix:
Gender:F
Credentials:LCSW, CSAYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 OLD SAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARMONY
Mailing Address - State:IN
Mailing Address - Zip Code:47631-9602
Mailing Address - Country:US
Mailing Address - Phone:812-774-3752
Mailing Address - Fax:
Practice Address - Street 1:812 OLD SAND RD
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:IN
Practice Address - Zip Code:47631-9602
Practice Address - Country:US
Practice Address - Phone:812-774-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010777A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical