Provider Demographics
NPI:1124070057
Name:MORENO, SYLVIA (LPC)
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10003 NW MILITARY HWY STE 2217
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1890
Mailing Address - Country:US
Mailing Address - Phone:210-316-4279
Mailing Address - Fax:866-232-0628
Practice Address - Street 1:10003 NW MILITARY HWY STE 2217
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1890
Practice Address - Country:US
Practice Address - Phone:210-403-2998
Practice Address - Fax:210-402-0418
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096048604Medicaid
TX096048606Medicaid