Provider Demographics
NPI:1932692290
Name:SKYE MOFFITT PH.D., PLLC
Entity Type:Organization
Organization Name:SKYE MOFFITT PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SKYE
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-549-8783
Mailing Address - Street 1:10300 N CENTRAL EXPY STE 510
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8600
Mailing Address - Country:US
Mailing Address - Phone:214-549-8783
Mailing Address - Fax:972-392-9695
Practice Address - Street 1:10300 N CENTRAL EXPY STE 510
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8600
Practice Address - Country:US
Practice Address - Phone:214-549-8783
Practice Address - Fax:972-392-9695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty