Provider Demographics
NPI:1235629445
Name:MOREE, MELISSA C (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:C
Last Name:MOREE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N. CYPRESS AVE.
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043
Mailing Address - Country:US
Mailing Address - Phone:912-381-4241
Mailing Address - Fax:904-592-7770
Practice Address - Street 1:13453 MAIN ST. NORTH
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218
Practice Address - Country:US
Practice Address - Phone:904-801-3794
Practice Address - Fax:904-339-9967
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021179900Medicaid