Provider Demographics
NPI:1649798778
Name:MORALEZ, LEIGH ANN (MS)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:MORALEZ
Suffix:
Gender:X
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17625
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-0625
Mailing Address - Country:US
Mailing Address - Phone:503-516-0941
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 17625
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-0625
Practice Address - Country:US
Practice Address - Phone:503-516-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor