Individual
EDGAR MORALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
606 3RD ST, POLK CITY, FL 33868-9051
(863) 399-8819
Mailing address
606 3RD ST, POLK CITY, FL 33868-9051
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1917854
DRIVERS LICENSE
PR
Enumeration date
03/20/2018
Last updated
03/20/2018
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