Healthcare Provider Details

I. General information

NPI: 1225095417
Provider Name (Legal Business Name): MELODYE JILL HORNISH M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 96A
HARRISVILLE WV
26362-9719
US

IV. Provider business mailing address

PO BOX 234
ELLENBORO WV
26346-0234
US

V. Phone/Fax

Practice location:
  • Phone: 304-869-3763
  • Fax: 304-869-3763
Mailing address:
  • Phone: 304-869-3763
  • Fax: 304-869-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number813
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: