Provider Demographics
NPI:1891954301
Name:MOORE, MELISSA L I (MSW, PLCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:L
Last Name:MOORE
Suffix:I
Gender:F
Credentials:MSW, PLCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2526
Mailing Address - Street 2:2934 MCCLELLAND BLVD
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2526
Mailing Address - Country:US
Mailing Address - Phone:417-347-7580
Mailing Address - Fax:417-347-7582
Practice Address - Street 1:1800 W 30TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1520
Practice Address - Country:US
Practice Address - Phone:417-347-7580
Practice Address - Fax:417-347-7582
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080140051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical