Healthcare Provider Details

I. General information

NPI: 1598007320
Provider Name (Legal Business Name): MOSELEY E MELLINGER LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 CARROLL LN
HAYNESVILLE LA
71038-7127
US

IV. Provider business mailing address

219 CARROLL LN
HAYNESVILLE LA
71038-7127
US

V. Phone/Fax

Practice location:
  • Phone: 318-927-6441
  • Fax: 318-927-6441
Mailing address:
  • Phone: 318-927-6441
  • Fax: 318-927-6441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2762
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number223804
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: