Healthcare Provider Details

I. General information

NPI: 1760614713
Provider Name (Legal Business Name): MELISSA MOSSFORD-CARROLL BCBA; LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 RYBAR LN
PALM COAST FL
32164-6445
US

IV. Provider business mailing address

23 RYBAR LN
PALM COAST FL
32164-6445
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-6658
  • Fax:
Mailing address:
  • Phone: 386-316-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: