Healthcare Provider Details

I. General information

NPI: 1265356851
Provider Name (Legal Business Name): MELLISA RHODA CHAWIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W PROSPER TRL STE 120
PROSPER TX
75078-3743
US

IV. Provider business mailing address

4301 OAK BLUFF RD
MELISSA TX
75454-2534
US

V. Phone/Fax

Practice location:
  • Phone: 469-715-1145
  • Fax:
Mailing address:
  • Phone: 469-715-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-520856
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: