Provider Demographics
NPI:1851667349
Name:MOIX, MELISSA (MS, LPE, SPS)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:MOIX
Suffix:
Gender:F
Credentials:MS, LPE, SPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 UTAH TRL
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3317
Mailing Address - Country:US
Mailing Address - Phone:501-908-9076
Mailing Address - Fax:
Practice Address - Street 1:1210 HOGAN LN STE 200
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8063
Practice Address - Country:US
Practice Address - Phone:501-932-0255
Practice Address - Fax:501-932-0258
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11-13E103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist