Provider Demographics
NPI:1073963062
Name:THOMPSON, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 STATE ROUTE 416 WEST
Mailing Address - Street 2:
Mailing Address - City:ROBARDS
Mailing Address - State:KY
Mailing Address - Zip Code:42452
Mailing Address - Country:US
Mailing Address - Phone:270-860-9392
Mailing Address - Fax:
Practice Address - Street 1:230 2ND ST
Practice Address - Street 2:SUITE 406
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3172
Practice Address - Country:US
Practice Address - Phone:270-826-8761
Practice Address - Fax:270-826-8737
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY76401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical