Provider Demographics
NPI:1619361706
Name:MORALES, PATRICIA VAIL (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:VAIL
Last Name:MORALES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 W FLETCHER ST
Mailing Address - Street 2:UNIT J
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1579 N MILWAUKEE AVE
Practice Address - Street 2:210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2452
Practice Address - Country:US
Practice Address - Phone:708-695-4869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009593101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional