Provider Demographics
NPI:1174192926
Name:MORALES, LAURA ELMA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELMA
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83091 LOS CABOS AVE
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-6319
Mailing Address - Country:US
Mailing Address - Phone:760-574-9284
Mailing Address - Fax:
Practice Address - Street 1:333 S FARRELL DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7905
Practice Address - Country:US
Practice Address - Phone:760-416-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI3494101YP2500X
CAAPCC12826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional