MEDICARE: RYAN MORGAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C007378	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1681	NC
3	1041C0700X	Clinical Social Worker	9781200-3501	UT

General Provider Information

NPI Number	:	1114242724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MORGAN LCSW

Provider Business Mailing Address
First Line	:	2886 E OQUIRRH DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2036
Country	:	US
Telephone Number	:	801-682-1715
Fax Number	:

Provider Business Practice Location Address
First Line	:	1399 S 700 E STE 16
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2170
Country	:	US
Telephone Number	:	801-682-1715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	12/20/2021

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