Individual provider Active NPI

Leo Mora Jr., PH.D, LMFT-S

  • Marriage & Family Therapist
  • Killeen, TX
National Provider Identifier
1750745055
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
202561 Issued in TX
Practice address
2403 Bacon Ranch Rd Ste 300
Killeen, TX 76542-3380
Phone
(254) 791-5614
Fax
(651) 305-9283
NPI assigned
Apr 12, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X 202561 TX
Family Psychologist 103TF0000X
Marriage & Family Therapist 106H00000X 202561 TX Primary

Addresses

Primary practice location

2403 Bacon Ranch Rd Ste 300
Killeen, TX 76542-3380

Mailing address

2403 Bacon Ranch Rd Ste 300
Killeen, TX 76542-3380
Phone (254) 654-5872

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.psychselect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240405001023 TX Practitioner - Marriage and Family Therapist 1456799758 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2403 Bacon Ranch Rd
Suite 300
Killeen, TX 76542-3380
Phone (254) 791-5614

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Leo Mora Therapy Services PLLC Marriage & Family Therapist CurrentSince Jan 22, 2024 Accepting new patients
The Shepherds New Pathways, LLC PastSince May 24, 2020 Accepting new patients
The Shepherds New Pathways, LLC Marriage & Family Therapist PastSince May 24, 2020 Accepting new patients

Locations

2403 Bacon Ranch Rd
Ste 300
Killeen, TX 76542
Phone (254) 654-4529

400 W Jasper Dr
Ste 100B
Killeen, TX 76542
Phone (254) 913-4341

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1750745055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 BACON RANCH RD STE 300",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765423380",
            "telephone_number": "254-654-5872",
            "fax_number": "651-305-9283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 BACON RANCH RD STE 300",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765423380",
            "telephone_number": "254-791-5614",
            "fax_number": "651-305-9283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORA",
        "first_name": "LEO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PH.D, LMFT-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-12",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "TX",
            "license": "202561",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "202561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.psychselect.com",
            "affiliation": "N",
            "endpointDescription": "Therapy Appointment",
            "address_1": "400 W Jasper Dr Ste 100B",
            "city": "Killeen",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765421322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

Verify at the official NPI Registry.