Provider Demographics
NPI:1235638206
Name:MOSS, EXELENA NYETA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:EXELENA
Middle Name:NYETA
Last Name:MOSS
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8190 BARKER CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1223
Mailing Address - Country:US
Mailing Address - Phone:346-445-7575
Mailing Address - Fax:
Practice Address - Street 1:8190 BARKER CYPRESS RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1223
Practice Address - Country:US
Practice Address - Phone:346-445-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4079103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst