Provider Demographics
NPI:1467996819
Name:MOYEN, MELISSA (BASW, MSW, LICENSED)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MOYEN
Suffix:
Gender:F
Credentials:BASW, MSW, LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 BROWN AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1868
Mailing Address - Country:US
Mailing Address - Phone:423-473-9542
Mailing Address - Fax:
Practice Address - Street 1:1340 BROWN AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1868
Practice Address - Country:US
Practice Address - Phone:423-473-9542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000640174101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool