Healthcare Provider Details

I. General information

NPI: 1144345109
Provider Name (Legal Business Name): CLIFFORD O MORGAN JR. PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 TELLES ST SW
LOS LUNAS NM
87031-8518
US

IV. Provider business mailing address

119 TELLES ST SW P.O. BOC 1757
LOS LUNAS NM
87031-8518
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-7100
  • Fax: 505-865-7100
Mailing address:
  • Phone: 505-865-7100
  • Fax: 505-865-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number174
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: