Provider Demographics
NPI:1770867426
Name:CLYDE, ALEXIS INABINET (PHD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:INABINET
Last Name:CLYDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 HARRY HINES BLVD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5259
Mailing Address - Country:US
Mailing Address - Phone:214-456-3261
Mailing Address - Fax:
Practice Address - Street 1:6300 HARRY HINES BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5259
Practice Address - Country:US
Practice Address - Phone:214-456-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35142103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent