Provider Demographics
NPI:1053116640
Name:BASHAM, MORGAN FAYTH
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:FAYTH
Last Name:BASHAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 TUNNEL HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8026
Mailing Address - Country:US
Mailing Address - Phone:270-765-2335
Mailing Address - Fax:
Practice Address - Street 1:1106 TUNNEL HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8026
Practice Address - Country:US
Practice Address - Phone:270-765-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional