Provider Demographics
NPI:1770050551
Name:GULLETT, ALEXIA
Entity type:Individual
Prefix:
First Name:ALEXIA
Middle Name:
Last Name:GULLETT
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 1:505 W UNIVERSITY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6643
Mailing Address - Country:US
Mailing Address - Phone:817-516-9100
Mailing Address - Fax:
Practice Address - Street 1:9390 RESEARCH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6585
Practice Address - Country:US
Practice Address - Phone:512-330-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36025261106S00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician