Provider Demographics
NPI:1356919245
Name:MORAL, MANUEL ALFREDO
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ALFREDO
Last Name:MORAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 VALLEYSIDE DR NE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-1082
Mailing Address - Country:US
Mailing Address - Phone:816-550-8303
Mailing Address - Fax:
Practice Address - Street 1:915 MONROE ST SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5007
Practice Address - Country:US
Practice Address - Phone:251-616-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4392103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling