Active NPI
Melanie Renee Moore
- Professional Counselor
- Pocatello, ID
National Provider Identifier
1063360758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4671296
- Practice address
- 396 Yellowstone Ave
Pocatello, ID 83201-4572 - Phone
- (385) 985-6354
- NPI assigned
- Mar 18, 2026
- Last updated
- Mar 18, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4671296 | ID | Primary |
Addresses
Primary practice location
396 Yellowstone Ave
Pocatello, ID 83201-4572
Mailing address
561 Raven Way
Chubbuck, ID 83202-1971
Phone (385) 985-6354
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4671296 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773792000000",
"number": "1063360758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "561 RAVEN WAY",
"city": "CHUBBUCK",
"state": "ID",
"postal_code": "832021971",
"telephone_number": "385-985-6354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "396 YELLOWSTONE AVE",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014572",
"telephone_number": "385-985-6354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MELANIE",
"middle_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-03-18",
"last_updated": "2026-03-18",
"certification_date": "2026-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "4671296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.