Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PS016401 | PA |
NPI | 1033380720 |
---|---|
Provider Name | Mrs. Melissa D Hunter |
First Address | State College, PA 16801-7641 |
Second Address | State College, PA 16801-7641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2008 |
Last Update Date | 20/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2021174 | BLUE SHIELD (01) | PA |