Provider Demographics
NPI:1386986271
Name:MOFFITT, ALEXIS M
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:M
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8317 WHITLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2483
Mailing Address - Country:US
Mailing Address - Phone:817-562-0300
Mailing Address - Fax:
Practice Address - Street 1:8317 WHITLEY RD
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2483
Practice Address - Country:US
Practice Address - Phone:817-562-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2485103K00000X
222Q00000X
TX1-18-32035103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist