MEDICARE: PHYLLIS MORALES IMH

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	101YM0800X	Mental Health Counselor	IMH26904	FL

General Provider Information

NPI Number	:	1508702119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS MORALES IMH

Provider Business Mailing Address
First Line	:	9015 TOWN CENTER PKWY UNIT 106
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-5012
Country	:	US
Telephone Number	:	941-567-6207
Fax Number	:

Provider Business Practice Location Address
First Line	:	9015 TOWN CENTER PKWY UNIT 106
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-5012
Country	:	US
Telephone Number	:	941-567-6207
Fax Number	:

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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