MEDICARE: MELLISSA ANN OWENS 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
1	103K00000X	Behavior Analyst	BACB589960	CA

General Provider Information

NPI Number	:	1598502908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELLISSA ANN OWENS BCBA

Provider Business Mailing Address
First Line	:	1151 WEST ST
Second Line	:
City	:	CORNING
State	:	CA
Zip	:	96021-2940
Country	:	US
Telephone Number	:	530-838-8141
Fax Number	:

Provider Business Practice Location Address
First Line	:	1851 HERITAGE LN STE 260
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4945
Country	:	US
Telephone Number	:	530-838-8141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2024
Last Update Date	:	07/12/2024

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