Provider Demographics
NPI:1366830697
Name:MONCEAUX, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MONCEAUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10034
Mailing Address - Street 2:EDUCATION BUILDING, ROOM 115
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77710-0034
Mailing Address - Country:US
Mailing Address - Phone:409-880-7681
Mailing Address - Fax:409-880-2252
Practice Address - Street 1:211 RED BIRD LANE
Practice Address - Street 2:EDUCATION BUILDING, ROOM 115
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77710-0034
Practice Address - Country:US
Practice Address - Phone:409-880-7681
Practice Address - Fax:409-880-2252
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional