Healthcare Provider Details

I. General information

NPI: 1740001213
Provider Name (Legal Business Name): MORGAN BAILEE BOGGESS MCCOY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 JACKSBORO RD
BRONSTON KY
42518-9654
US

IV. Provider business mailing address

212 JACKSBORO RD
BRONSTON KY
42518-9654
US

V. Phone/Fax

Practice location:
  • Phone: 606-278-2499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number259730
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number256607
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: