Provider Demographics
NPI:1922067156
Name:HUENE, MELANIE (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:HUENE
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 S CLARIZZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5523
Mailing Address - Country:US
Mailing Address - Phone:812-355-5890
Mailing Address - Fax:812-355-5895
Practice Address - Street 1:1001 HADLEY RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1794
Practice Address - Country:US
Practice Address - Phone:317-834-5756
Practice Address - Fax:317-834-5782
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041987A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical