Healthcare Provider Details

I. General information

NPI: 1346471620
Provider Name (Legal Business Name): MELISSA MEILIAN HARLOW MOORE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 NORTHCUTT AVE
LONGVIEW TX
75601-5247
US

IV. Provider business mailing address

310 NORTHCUTT AVE
LONGVIEW TX
75601-5247
US

V. Phone/Fax

Practice location:
  • Phone: 405-426-0396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number83746
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number289203
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: