Provider Demographics
NPI:1598007320
Name:MELLINGER, MOSELEY E (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:MOSELEY
Middle Name:E
Last Name:MELLINGER
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CARROLL LN
Mailing Address - Street 2:
Mailing Address - City:HAYNESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71038-7127
Mailing Address - Country:US
Mailing Address - Phone:318-927-6441
Mailing Address - Fax:318-927-6441
Practice Address - Street 1:219 CARROLL LN
Practice Address - Street 2:
Practice Address - City:HAYNESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71038-7127
Practice Address - Country:US
Practice Address - Phone:318-927-6441
Practice Address - Fax:318-927-6441
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2762101YP2500X
NC223804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional