Individual
DR. MELODY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1395 MISSOURI AVE, LAS CRUCES, NM 88001-5327
(832) 264-4454
(949) 863-5159
Mailing address
5445 ALMEDA RD, SUITE 407, HOUSTON, TX 77004-7434
(832) 264-4454
(186) 634-3101
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
15121
TX
103T00000X
Psychologist
34928
TX
103T00000X
Psychologist
PSY-RXC0083
NM
103TA0400X
Addiction (Substance Use Disorder) Psychologist
34928
TX
103TA0400X
Addiction (Substance Use Disorder) Psychologist
PSY-RXC0083
NM
103TC0700X
Clinical Psychologist
Primary
34928
TX
103TM1800X
Intellectual & Developmental Disabilities Psychologist
34928
TX
103TP0016X
Prescribing (Medical) Psychologist
PSY-RXC0083
NM
103TP2701X
Group Psychotherapy Psychologist
34928
TX
103TS0200X
School Psychologist
34531
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1T9043
MEDICARE PTAN
NM
05
—
308 647 201
—
TX
05
—
88575705
—
NM
Enumeration date
02/16/2010
Last updated
07/10/2023
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