Provider Demographics
NPI:1184946360
Name:MOORE, MELODY (PHD)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 ALMEDA RD
Mailing Address - Street 2:SUITE 407
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7434
Mailing Address - Country:US
Mailing Address - Phone:832-264-4454
Mailing Address - Fax:186-634-3101
Practice Address - Street 1:1395 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5327
Practice Address - Country:US
Practice Address - Phone:832-264-4454
Practice Address - Fax:949-863-5159
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15121101Y00000X
NMPSY-RXC0083103T00000X, 103TA0400X, 103TP0016X
TX34928103T00000X, 103TA0400X, 103TM1800X, 103TP2701X, 103TC0700X
TX34531103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1T9043OtherMEDICARE PTAN
TX308 647 201Medicaid
NM88575705Medicaid