Provider Demographics
NPI:1841908191
Name:MORA, BERNARDO (MED, LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:BERNARDO
Middle Name:
Last Name:MORA
Suffix:
Gender:M
Credentials:MED, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 FRIARS CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-0073
Mailing Address - Country:US
Mailing Address - Phone:956-280-1567
Mailing Address - Fax:
Practice Address - Street 1:2330 W US HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-7778
Practice Address - Country:US
Practice Address - Phone:956-361-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88609101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health