Provider Demographics
NPI:1588908545
Name:MORGAN, CARRIE ELLEN (PHD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELLEN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ELLEN
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-5159
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:102 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-261-5159
Practice Address - Fax:601-545-1740
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS52 905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05782589Medicaid
MS6092139OtherHEALTHSPRINGS
MS6092139OtherHEALTHSPRINGS