Provider Demographics
NPI:1750935391
Name:LEO MORA THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:LEO MORA THERAPY SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-791-5614
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:254-791-5614
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750745055OtherTREST,BCBSTX,SWHP,MAGELLAN HEALTHCARE,CIGNA