Provider Demographics
NPI:1114150711
Name:MORENO, KARLA T (M ED, LPC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:T
Last Name:MORENO
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 SUPERIOR DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5703
Mailing Address - Country:US
Mailing Address - Phone:830-758-7037
Mailing Address - Fax:830-757-1278
Practice Address - Street 1:2944 SUPERIOR DR
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5703
Practice Address - Country:US
Practice Address - Phone:830-758-7037
Practice Address - Fax:830-757-1278
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11341133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health