Provider Demographics
NPI:1538052477
Name:MOOREHEAD, NYASA N
Entity type:Individual
Prefix:
First Name:NYASA
Middle Name:N
Last Name:MOOREHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 BRICE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8575
Mailing Address - Country:US
Mailing Address - Phone:614-984-4989
Mailing Address - Fax:
Practice Address - Street 1:5008 BRICE MEADOW DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8575
Practice Address - Country:US
Practice Address - Phone:614-984-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health