Provider Demographics
NPI:1558452128
Name:GADNEY-MOSS, BLANCA LETICIA (MA LPC LMFT NCC)
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:LETICIA
Last Name:GADNEY-MOSS
Suffix:
Gender:F
Credentials:MA LPC LMFT NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5618
Mailing Address - Country:US
Mailing Address - Phone:915-351-8030
Mailing Address - Fax:915-566-1811
Practice Address - Street 1:1418 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5618
Practice Address - Country:US
Practice Address - Phone:915-351-8030
Practice Address - Fax:915-566-1811
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10776101Y00000X
TX2214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist