Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 15121 | TX |
N | 102L00000X | Psychologist | 34928 | TX |
N | 103T00000X | Psychologist | 34928 | TX |
N | 102L00000X | Psychologist | PSY-RXC0083 | NM |
N | 103T00000X | Psychologist | PSY-RXC0083 | NM |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 34928 | TX |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY-RXC0083 | NM |
Y | 103G00000X | Clinical Psychologist | 34928 | TX |
Y | 103TC0700X | Clinical Psychologist | 34928 | TX |
N | 103TM1800X | Intellectual & Developmental Disabilities | 34928 | TX |
N | 103TP0016X | Prescribing (Medical) | PSY-RXC0083 | NM |
N | 103TP2701X | Group Psychotherapist | 34928 | TX |
N | 103TS0200X | School Psychologist | 34531 | TX |
NPI | 1184946360 |
---|---|
Provider Name | Dr. Melody Moore |
First Address | Houston, TX 77004-7434 |
Second Address | Las Cruces, NM 88001-5327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2010 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1T9043 | MEDICARE PTAN (01) | NM |
308 647 201 | (05) | TX |
88575705 | (05) | NM |