=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851573299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. MELANIE MARIE HEPBURN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2007
-----------------------------------------------------
Last Update Date | 11/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5351 JAYCEE AVE # C SUITE1
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17112-2938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-657-2290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 SAM SNEAD CIR
-----------------------------------------------------
City | ETTERS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17319-9746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-932-1607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC000424
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------