Healthcare Provider Details

I. General information

NPI: 1184946360
Provider Name (Legal Business Name): MELODY MOORE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 MISSOURI AVE
LAS CRUCES NM
88001-5327
US

IV. Provider business mailing address

5445 ALMEDA RD SUITE 407
HOUSTON TX
77004-7434
US

V. Phone/Fax

Practice location:
  • Phone: 832-264-4454
  • Fax: 949-863-5159
Mailing address:
  • Phone: 832-264-4454
  • Fax: 186-634-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number15121
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-RXC0083
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34928
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number34928
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY-RXC0083
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number34928
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPSY-RXC0083
License Number StateNM
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number34928
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number34531
License Number StateTX
# 10
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34928
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: