Healthcare Provider Details

I. General information

NPI: 1942582820
Provider Name (Legal Business Name): MELISA MOORE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 ORANGE AVE E
TALLAHASSEE FL
32311-6144
US

IV. Provider business mailing address

2181 ORANGE AVE E
TALLAHASSEE FL
32311-6144
US

V. Phone/Fax

Practice location:
  • Phone: 850-513-7521
  • Fax:
Mailing address:
  • Phone: 850-513-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003822
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: