MEDICARE: MELISSA HARNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	11415480	IN

General Provider Information

NPI Number	:	1437576329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA HARNESS

Provider Business Mailing Address
First Line	:	1800 W 900 S
Second Line	:
City	:	FLAT ROCK
State	:	IN
Zip	:	47234-9773
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 W 900 S
Second Line	:
City	:	FLAT ROCK
State	:	IN
Zip	:	47234-9773
Country	:	US
Telephone Number	:	317-512-3063
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2014
Last Update Date	:	03/28/2014

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Directions to “ MELISSA HARNESS ” Practice Location

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