MEDICARE: ELIAS MORAN JR. LPC

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	101YP2500X	Professional Counselor	LPC17482	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427480631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIAS MORAN JR. LPC

Provider Business Mailing Address
First Line	:	PO BOX 129
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-0129
Country	:	US
Telephone Number	:	623-466-4159
Fax Number	:	623-439-7349

Provider Business Practice Location Address
First Line	:	11225 N 28TH DR STE C206
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5600
Country	:	US
Telephone Number	:	623-466-4159
Fax Number	:	623-439-7349

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

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	09/19/2022

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