MEDICARE: DR. MELISSA E GARRETT-MOULTRIE

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor	85817	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689932097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA E GARRETT-MOULTRIE

Provider Business Mailing Address
First Line	:	5119 LOST COVE LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-7977
Country	:	US
Telephone Number	:	281-323-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	5119 LOST COVE LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-7977
Country	:	US
Telephone Number	:	281-323-2611
Fax Number	:

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

Provider Enumeration Date	:	04/24/2012
Last Update Date	:	04/30/2021

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