Provider Demographics
NPI:1215008370
Name:MORALE, ELIZABETH GRACEY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GRACEY
Last Name:MORALE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MORALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:9603 WHITE ROCK TRL STE 119
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5058
Mailing Address - Country:US
Mailing Address - Phone:214-923-7872
Mailing Address - Fax:214-594-0009
Practice Address - Street 1:9603 WHITE ROCK TRL STE 119
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5058
Practice Address - Country:US
Practice Address - Phone:214-923-7872
Practice Address - Fax:214-594-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180942801Medicaid