Provider Demographics
NPI:1205935962
Name:POKORNY, MELODY DAWN (IMF)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:DAWN
Last Name:POKORNY
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6348
Mailing Address - Country:US
Mailing Address - Phone:760-726-6519
Mailing Address - Fax:
Practice Address - Street 1:3142 VISTA WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3619
Practice Address - Country:US
Practice Address - Phone:760-758-1480
Practice Address - Fax:760-435-9472
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 43678106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist