Provider Demographics
NPI:1396577706
Name:SEALE, ALEXANDRA DANIELLE
Entity type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:DANIELLE
Last Name:SEALE
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 1:905 ROBERTS CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:RIVER OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76114-2825
Mailing Address - Country:US
Mailing Address - Phone:817-731-2293
Mailing Address - Fax:
Practice Address - Street 1:6110 MADOC FORK DR APT 1136
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5882
Practice Address - Country:US
Practice Address - Phone:817-999-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician