Provider Demographics
NPI:1225095417
Name:HORNISH, MELODYE JILL (MA)
Entity Type:Individual
Prefix:
First Name:MELODYE
Middle Name:JILL
Last Name:HORNISH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:WV
Mailing Address - Zip Code:26346-0234
Mailing Address - Country:US
Mailing Address - Phone:304-869-3763
Mailing Address - Fax:304-869-3763
Practice Address - Street 1:RR 1 BOX 96A
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362-9719
Practice Address - Country:US
Practice Address - Phone:304-869-3763
Practice Address - Fax:304-869-3763
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV813103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9202089000Medicaid