Provider Demographics
NPI:1871816629
Name:MORALES, GILBERT JR (LADAC)
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:
Last Name:MORALES
Suffix:JR
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 N ROADRUNNER PKWY APT 2404
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7040
Mailing Address - Country:US
Mailing Address - Phone:575-520-5175
Mailing Address - Fax:
Practice Address - Street 1:251 N ROADRUNNER PKWY APT 2404
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7040
Practice Address - Country:US
Practice Address - Phone:575-520-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0130291101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)