Healthcare Provider Details

I. General information

NPI: 1942445879
Provider Name (Legal Business Name): MORGAN COY LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MUHAMMAD ALI BLVD
LOUISVILLE KY
40202-1423
US

IV. Provider business mailing address

78 SHANNON PL
SHELBYVILLE KY
40065-6359
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8600
  • Fax:
Mailing address:
  • Phone: 812-569-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number166046
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: