Provider Demographics
NPI:1710178413
Name:MORENO, PABLO (LPC)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 CENTER POINTE DR.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-687-8000
Mailing Address - Fax:956-687-8009
Practice Address - Street 1:3118 CENTER POINTE DR.
Practice Address - Street 2:SUITE 3
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-687-8000
Practice Address - Fax:956-687-8009
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1857831-01Medicaid
TX185783101Medicaid