MEDICARE: MELANIE RENEE MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4671296	ID

General Provider Information

NPI Number	:	1063360758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE RENEE MOORE

Provider Business Mailing Address
First Line	:	561 RAVEN WAY
Second Line	:
City	:	CHUBBUCK
State	:	ID
Zip	:	83202-1971
Country	:	US
Telephone Number	:	385-985-6354
Fax Number	:

Provider Business Practice Location Address
First Line	:	396 YELLOWSTONE AVE
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83201-4572
Country	:	US
Telephone Number	:	385-985-6354
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ MELANIE RENEE MOORE ” Practice Location

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