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NPI Code Detail

MEDICARE: MELEAH ACKLEY BCBA

MEDICARE: MELEAH ACKLEY BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor13077NE
2103K00000XBehavior Analyst2023NC
3103K00000XBehavior Analyst241025MS

General Provider Information

NPI Number : 1588103766
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELEAH ACKLEY BCBA
Provider Business Mailing Address
First Line : 32 MILLBRANCH RD STE 20
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-1673
Country : US
Telephone Number : 601-255-5264
Fax Number :
Provider Business Practice Location Address
First Line : 32 MILLBRANCH RD STE 20
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-1673
Country : US
Telephone Number : 601-255-5264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2017
Last Update Date : 11/05/2024

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