Provider Demographics
NPI:1720418247
Name:MORALES, JOSE (COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 W FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2442
Mailing Address - Country:US
Mailing Address - Phone:323-750-7580
Mailing Address - Fax:323-758-6095
Practice Address - Street 1:1030 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2442
Practice Address - Country:US
Practice Address - Phone:323-750-7580
Practice Address - Fax:323-758-6095
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)