Provider Demographics
NPI:1770168841
Name:MORALES, KANDICE (LMFTA)
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10291 N MERIDIAN ST STE 250
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1076
Mailing Address - Country:US
Mailing Address - Phone:317-731-2672
Mailing Address - Fax:
Practice Address - Street 1:10291 N MERIDIAN ST STE 250
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46290-1076
Practice Address - Country:US
Practice Address - Phone:317-731-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000430A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN85000430AOtherLICENSE