Provider Demographics
NPI:1194480095
Name:MORALES, JENNIFER ALYSSA
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALYSSA
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 1:401 S TUSTIN ST BLDG D
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2550
Mailing Address - Country:US
Mailing Address - Phone:714-289-3936
Mailing Address - Fax:
Practice Address - Street 1:401 S TUSTIN ST BLDG D
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2550
Practice Address - Country:US
Practice Address - Phone:714-289-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst