Provider Demographics
NPI:1962212241
Name:SMART, MORGAN
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:SMART
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:133 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5713
Mailing Address - Country:US
Mailing Address - Phone:337-431-7194
Mailing Address - Fax:
Practice Address - Street 1:133 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5713
Practice Address - Country:US
Practice Address - Phone:337-431-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator