Provider Demographics
NPI:1255158796
Name:MORALES, SANTIAGO RUIZ III (LMSW)
Entity type:Individual
Prefix:MR
First Name:SANTIAGO
Middle Name:RUIZ
Last Name:MORALES
Suffix:III
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 LECOMPTE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5357
Mailing Address - Country:US
Mailing Address - Phone:919-895-0317
Mailing Address - Fax:
Practice Address - Street 1:700 SE INNER LOOP
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7700
Practice Address - Country:US
Practice Address - Phone:512-942-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112384104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker