Healthcare Provider Details

I. General information

NPI: 1144856485
Provider Name (Legal Business Name): NYX SPIRIT MELODY LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NICHOLAS SCOTT MORAN LMHC

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 UNIVERSITY PL FL 11
NEW YORK NY
10003-4527
US

IV. Provider business mailing address

113 UNIVERSITY PL FL 11
NEW YORK NY
10003-4527
US

V. Phone/Fax

Practice location:
  • Phone: 717-439-6274
  • Fax:
Mailing address:
  • Phone: 717-439-6274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: