Provider Demographics
NPI:1831685759
Name:MORA, JACQUELINE LALLY (LPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LALLY
Last Name:MORA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:V
Other - Last Name:LALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10809 WESTWOOD LOOP APT 1334
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5709
Mailing Address - Country:US
Mailing Address - Phone:985-640-6160
Mailing Address - Fax:
Practice Address - Street 1:21252 GATHERING OAK # 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-3458
Practice Address - Country:US
Practice Address - Phone:830-730-6090
Practice Address - Fax:830-455-4355
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7452101YM0800X
TX92836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health