Provider Demographics
NPI:1043564263
Name:MORETTA GUERRERO, BRENDA MORETTA (PHD, LPC, FT)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:MORETTA
Last Name:MORETTA GUERRERO
Suffix:
Gender:F
Credentials:PHD, LPC, FT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 EARLSTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6097
Mailing Address - Country:US
Mailing Address - Phone:210-213-6460
Mailing Address - Fax:
Practice Address - Street 1:1227 EARLSTON DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6097
Practice Address - Country:US
Practice Address - Phone:210-213-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional