Provider Demographics
NPI:1710078555
Name:MARLEY, MELODY E (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:E
Last Name:MARLEY
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:E
Other - Last Name:EDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1810 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-5737
Mailing Address - Country:US
Mailing Address - Phone:765-553-5691
Mailing Address - Fax:765-553-5772
Practice Address - Street 1:1810 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-5737
Practice Address - Country:US
Practice Address - Phone:765-553-5691
Practice Address - Fax:765-553-5772
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042895A103T00000X, 103TC1900X, 103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000992378OtherANTHEM BC/BS
IN7687958OtherAETNA
IN537605OtherVALUE OPTIONS
IN567370OtherVALUE OPTIONS
IN100124250Medicaid
IN350868083OtherTRICARE
IN100124250Medicaid