Provider Demographics
NPI:1801945415
Name:MOFFITT, SKYE PORTER (PHD)
Entity type:Individual
Prefix:DR
First Name:SKYE
Middle Name:PORTER
Last Name:MOFFITT
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 1:6350 LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE 151
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6403
Mailing Address - Country:US
Mailing Address - Phone:214-549-8783
Mailing Address - Fax:972-392-9695
Practice Address - Street 1:6350 LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE 151
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6403
Practice Address - Country:US
Practice Address - Phone:214-549-8783
Practice Address - Fax:972-392-9695
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0065MXOtherBLUE CROSS BLUE SHIELD