Provider Demographics
NPI:1518475854
Name:MOXLOW SWAN, MELISSA M (MS, LPC, LPC-S)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:MOXLOW SWAN
Suffix:
Gender:F
Credentials:MS, LPC, LPC-S
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARY ANN
Other - Last Name:MOXLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10740 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2426
Mailing Address - Country:US
Mailing Address - Phone:907-600-4847
Mailing Address - Fax:
Practice Address - Street 1:10740 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2426
Practice Address - Country:US
Practice Address - Phone:907-600-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK118139101Y00000X, 101YM0800X
118139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty