Healthcare Provider Details

I. General information

NPI: 1629683396
Provider Name (Legal Business Name): ELEXENIA MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 OAKMONT ESTATES BLVD
WELLINGTON FL
33414-9357
US

IV. Provider business mailing address

3415 OAKMONT ESTATES BLVD
WELLINGTON FL
33414-9357
US

V. Phone/Fax

Practice location:
  • Phone: 561-791-6284
  • Fax:
Mailing address:
  • Phone: 718-666-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21255
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT2929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: