Provider Demographics
NPI:1750745055
Name:MORA, LEO JR (PHD, LMFT-S)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:MORA
Suffix:JR
Gender:M
Credentials:PHD, LMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 BACON RANCH RD STE 300
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-3380
Mailing Address - Country:US
Mailing Address - Phone:254-654-5872
Mailing Address - Fax:651-305-9283
Practice Address - Street 1:2403 BACON RANCH RD STE 300
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3380
Practice Address - Country:US
Practice Address - Phone:254-791-5614
Practice Address - Fax:651-305-9283
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202561103TB0200X, 106H00000X
103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily