Provider Demographics
NPI:1619939626
Name:BIGGS, MELANIE MOORE (PHD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MOORE
Last Name:BIGGS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:MOORE
Other - Last Name:BIGGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:BAYLOR SCOTT & WHITE MEDICAL PSYCHOLOGY CONSULTANTS
Mailing Address - Street 2:3600 GASTON AVENUE, BARNETT TOWER - SUITE 404
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1804
Mailing Address - Country:US
Mailing Address - Phone:214-820-5516
Mailing Address - Fax:214-820-5518
Practice Address - Street 1:BAYLOR SCOTT & WHITE MEDICAL PSYCHOLOGY CONSULTANTS
Practice Address - Street 2:3600 GASTON AVENUE, BARNETT TOWER - SUITE 404
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1804
Practice Address - Country:US
Practice Address - Phone:214-820-5516
Practice Address - Fax:214-820-5518
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25053103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175131501Medicaid
R55054Medicare UPIN
TX175131501Medicaid