Provider Demographics
NPI:1780809509
Name:MORALES, PETRA P (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:PETRA
Middle Name:P
Last Name:MORALES
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 W CLARE ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-3235
Mailing Address - Country:US
Mailing Address - Phone:361-354-4792
Mailing Address - Fax:
Practice Address - Street 1:815 N TYLER ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-4135
Practice Address - Country:US
Practice Address - Phone:361-354-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional