Healthcare Provider Details

I. General information

NPI: 1669083473
Provider Name (Legal Business Name): DAISY MORALES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 W CLEVELAND ST
SAINT JOHNS AZ
85936-4501
US

IV. Provider business mailing address

PO BOX 579
SAINT JOHNS AZ
85936-0579
US

V. Phone/Fax

Practice location:
  • Phone: 928-337-4301
  • Fax: 928-337-2269
Mailing address:
  • Phone: 928-337-4301
  • Fax: 928-337-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC19120
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: