Provider Demographics
NPI:1619778339
Name:VEGA-MORALES, IRENE LILYANA (LAC)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:LILYANA
Last Name:VEGA-MORALES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 W ELLIOT RD STE 207
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5142
Mailing Address - Country:US
Mailing Address - Phone:480-818-6777
Mailing Address - Fax:
Practice Address - Street 1:1425 W ELLIOT RD STE 207
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5142
Practice Address - Country:US
Practice Address - Phone:480-818-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08269T101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional