Provider Demographics
NPI:1306395751
Name:HORNE, MELISSA (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:HORNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 S HIGHLAND DR STE E5
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6469
Mailing Address - Country:US
Mailing Address - Phone:514-080-1528
Mailing Address - Fax:801-769-0564
Practice Address - Street 1:8170 S HIGHLAND DR STE E5
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6469
Practice Address - Country:US
Practice Address - Phone:514-080-1528
Practice Address - Fax:801-769-0564
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004483103TC1900X
UT10162580-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling