Provider Demographics
NPI:1164173563
Name:MORELL, LUIS D
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:D
Last Name:MORELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:D
Other - Last Name:MORELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17660 NW 67TH AVE APT 1602
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5872
Mailing Address - Country:US
Mailing Address - Phone:786-619-4449
Mailing Address - Fax:
Practice Address - Street 1:7601 SW 39TH ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2716
Practice Address - Country:US
Practice Address - Phone:954-401-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLBACB639585106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE06040122OtherABA