Provider Demographics
NPI:1144856485
Name:MELODY, NYX SPIRIT (LMHC)
Entity type:Individual
Prefix:
First Name:NYX
Middle Name:SPIRIT
Last Name:MELODY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:SCOTT
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:113 UNIVERSITY PL FL 11
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4527
Mailing Address - Country:US
Mailing Address - Phone:717-439-6274
Mailing Address - Fax:
Practice Address - Street 1:113 UNIVERSITY PL FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4527
Practice Address - Country:US
Practice Address - Phone:717-439-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10277OtherLICENSED MENTAL HEALTH COUNSELOR