Provider Demographics
NPI:1316951353
Name:MORGAN, ROGER HOWARD (PSYD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:HOWARD
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 1:14465 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-4699
Mailing Address - Country:US
Mailing Address - Phone:760-244-5757
Mailing Address - Fax:760-244-2767
Practice Address - Street 1:14465 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-4699
Practice Address - Country:US
Practice Address - Phone:760-244-5757
Practice Address - Fax:760-244-2767
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 101610Medicaid
CAPSY 101610Medicaid