Provider Demographics
NPI:1730505181
Name:MOORE, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SALZER MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2850 WINSLOW AVE
Mailing Address - Street 2:MLC 9700
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1169
Mailing Address - Country:US
Mailing Address - Phone:513-636-0225
Mailing Address - Fax:513-636-0661
Practice Address - Street 1:2850 WINSLOW AVE
Practice Address - Street 2:MLC 9700
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1169
Practice Address - Country:US
Practice Address - Phone:513-636-0225
Practice Address - Fax:513-636-0661
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0600515-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional