Healthcare Provider Details

I. General information

NPI: 1225259070
Provider Name (Legal Business Name): MELISSA VALENTINE RUGE M.ED., BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 QUEENSBOROUGH BLVD STE 102
MT PLEASANT SC
29464-3682
US

IV. Provider business mailing address

181 W PROFESSIONAL PARK CT STE 1
BOWLING GREEN KY
42104-3250
US

V. Phone/Fax

Practice location:
  • Phone: 843-352-7049
  • Fax: 803-905-4431
Mailing address:
  • Phone: 270-777-9283
  • Fax: 270-777-9283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-13910
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: