Provider Demographics
NPI:1851846182
Name:MORALES, VIVIEN-LEIGH
Entity Type:Individual
Prefix:
First Name:VIVIEN-LEIGH
Middle Name:
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 1:12810 HEACOCK ST STE B202
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-2873
Mailing Address - Country:US
Mailing Address - Phone:951-247-6542
Mailing Address - Fax:951-247-6959
Practice Address - Street 1:12810 HEACOCK ST STE B202
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-2873
Practice Address - Country:US
Practice Address - Phone:951-247-6542
Practice Address - Fax:951-247-6959
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist