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General NPI Number Information
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NPI Number | 1538762265
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Entity Type | Individual
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Provider Name | MELANI IRENE MOOD TLLP, CAADC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 1200 N WEST AVE
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City | JACKSON
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State | MI
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Zip | 49202-2179
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Country | US
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Telephone | 615-578-6508
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 N WEST AVE
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City | JACKSON
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State | MI
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Zip | 49202-2179
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 6362009521
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362009521
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License Number State | MI
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