Provider Demographics
NPI:1689714149
Name:CARTER-HACK, MELANIE RENEE (LMFT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:RENEE
Last Name:CARTER-HACK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 N LONG GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CECILIA
Mailing Address - State:KY
Mailing Address - Zip Code:42724-9543
Mailing Address - Country:US
Mailing Address - Phone:270-427-0895
Mailing Address - Fax:502-349-6450
Practice Address - Street 1:901 ATKINSON HILL AVENUE
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-348-9048
Practice Address - Fax:502-349-6450
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid