Healthcare Provider Details

I. General information

NPI: 1760778153
Provider Name (Legal Business Name): TSONG MORALES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S MCCLINTOCK DR STE. 105
TEMPE AZ
85282-2692
US

IV. Provider business mailing address

1400 E. SOUTHERN AVE STE. 735
TEMPE AZ
85282-2692
US

V. Phone/Fax

Practice location:
  • Phone: 480-804-0326
  • Fax: 480-804-0083
Mailing address:
  • Phone: 480-804-0326
  • Fax: 480-804-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW13305
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: