Healthcare Provider Details

I. General information

NPI: 1407731045
Provider Name (Legal Business Name): GABRIELLE LAXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 N TARRANT PKWY STE 250
FORT WORTH TX
76244-5451
US

IV. Provider business mailing address

5320 N TARRANT PKWY STE 250
FORT WORTH TX
76244-5451
US

V. Phone/Fax

Practice location:
  • Phone: 682-900-1444
  • Fax: 432-322-4597
Mailing address:
  • Phone: 682-900-1444
  • Fax: 432-322-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: