Healthcare Provider Details

I. General information

NPI: 1306395751
Provider Name (Legal Business Name): MELISSA HORNE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 S HIGHLAND DR STE E5
SANDY UT
84093-6469
US

IV. Provider business mailing address

8170 S HIGHLAND DR STE E5
SANDY UT
84093-6469
US

V. Phone/Fax

Practice location:
  • Phone: 514-080-1528
  • Fax: 801-769-0564
Mailing address:
  • Phone: 514-080-1528
  • Fax: 801-769-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY.0004483
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number10162580-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: