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General NPI Number Information
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NPI Number | 1467996819
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Entity Type | Individual
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Provider Name | MELISSA MOYEN BASW, MSW, LICENSED
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Gender | Female
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 1340 BROWN AVE NW
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City | CLEVELAND
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State | TN
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Zip | 37311-1868
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Country | US
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Telephone | 423-473-9542
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 BROWN AVE NW
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City | CLEVELAND
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State | TN
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Zip | 37311-1868
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Country | US
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Telephone | 423-473-9542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 000640174
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License Number State | TN
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