Provider Demographics
NPI:1780864546
Name:FORE, MELODY
Entity Type:Individual
Prefix:MISS
First Name:MELODY
Middle Name:
Last Name:FORE
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 1:208 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2114
Mailing Address - Country:US
Mailing Address - Phone:618-392-3090
Mailing Address - Fax:618-392-2754
Practice Address - Street 1:504 MICAH DRIVE
Practice Address - Street 2:DRAWER M
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450
Practice Address - Country:US
Practice Address - Phone:618-395-4306
Practice Address - Fax:618-395-4507
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health