Provider Demographics
NPI:1235998154
Name:MINTON FELDER, ALEXANDRIA LYNN
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:LYNN
Last Name:MINTON FELDER
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 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 PECAN STREET
Practice Address - Street 2:
Practice Address - City:FORRESTON
Practice Address - State:TX
Practice Address - Zip Code:76041
Practice Address - Country:US
Practice Address - Phone:469-570-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-331922106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician