MEDICARE: MRS. IDIANA MORALES LMHC

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	103K00000X	Behavior Analyst
2	101YM0800X	Mental Health Counselor	MH9102	FL

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	:	1730386178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IDIANA MORALES LMHC

Provider Business Mailing Address
First Line	:	14361 NW 87TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33018-8045
Country	:	US
Telephone Number	:	305-924-3230
Fax Number	:

Provider Business Practice Location Address
First Line	:	4385 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7628
Country	:	US
Telephone Number	:	305-924-3230
Fax Number	:

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	03/14/2025

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