Provider Demographics
NPI:1184185019
Name:IN, AHLEXUS VALERIE MOEUN
Entity Type:Individual
Prefix:
First Name:AHLEXUS VALERIE
Middle Name:MOEUN
Last Name:IN
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 1:5067 E TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93725-1244
Mailing Address - Country:US
Mailing Address - Phone:559-408-4546
Mailing Address - Fax:
Practice Address - Street 1:5067 E TOWER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-1244
Practice Address - Country:US
Practice Address - Phone:559-408-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARY2077017103K00000X
CAY2077017103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst