Individual
MELANI IRENE MOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TLLP, CAADC
Contact information
Practice address
1200 N WEST AVE, JACKSON, MI 49202-2179
(615) 578-6508
Mailing address
1200 N WEST AVE, JACKSON, MI 49202-2179
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6362009521
MI
103TA0400X
Addiction (Substance Use Disorder) Psychologist
6362009521
MI
106S00000X
Behavior Technician
—
—
Other
Enumeration date
11/17/2020
Last updated
07/17/2024
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