Provider Demographics
NPI:1972346237
Name:MELHORN, ALEXIS KAY
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KAY
Last Name:MELHORN
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 1:356 CUMMINGS ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-8549
Mailing Address - Country:US
Mailing Address - Phone:570-541-5507
Mailing Address - Fax:
Practice Address - Street 1:1722 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1285
Practice Address - Country:US
Practice Address - Phone:570-541-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician