Provider Demographics
NPI:1386154458
Name:MORGAN, LUKEITHER DENISE (PCCSS)
Entity type:Individual
Prefix:MS
First Name:LUKEITHER
Middle Name:DENISE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PCCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 & 158 HWY 51 NORTH
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606
Mailing Address - Country:US
Mailing Address - Phone:662-712-6257
Mailing Address - Fax:
Practice Address - Street 1:156 & 158 HWY 51 NORTH
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606
Practice Address - Country:US
Practice Address - Phone:662-712-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1396196879OtherBEHAVIORAL HEALTH