Provider Demographics
NPI:1669083473
Name:MORALES, DAISY (LPC)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:LPC
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 579
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-0579
Mailing Address - Country:US
Mailing Address - Phone:928-337-4301
Mailing Address - Fax:928-337-2269
Practice Address - Street 1:470 W CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936-4501
Practice Address - Country:US
Practice Address - Phone:928-337-4301
Practice Address - Fax:928-337-2269
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC19120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC19120OtherSTATE OF ARIZONA LICENSE