=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215497177
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA CLARA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2019
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9000 E NICHOLS AVE STE 100
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-706-3396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10346 PARK MEADOWS DR APT 2120
-----------------------------------------------------
City | LONE TREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-6873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-417-7654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-22-60840
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------