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General NPI Number Information
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NPI Number | 1467639898
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Entity Type | Organization
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Legal Business Name | MELODIE K MOOREHEAD, PHD, ABPP, PA
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 1201 E BROWARD BLVD
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-2133
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Country | US
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Telephone | 954-444-1445
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 E BROWARD BLVD
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-2133
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Country | US
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Telephone | 954-444-1445
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MELODIE K MOOREHEAD
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Credential | PHD
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Telephone | 954-444-1445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY4324
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License Number State | FL
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