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NPI Code Detail

MEDICARE: MELISSA ANDERSON MA, BCBA, LBA

MEDICARE: MELISSA ANDERSON MA, BCBA, LBA
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
1103K00000XBehavior AnalystAZ

General Provider Information

NPI Number : 1649790106
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA ANDERSON MA, BCBA, LBA
Provider Business Mailing Address
First Line : 1648 E CIELO GRANDE AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85024-2494
Country : US
Telephone Number : 630-881-9300
Fax Number :
Provider Business Practice Location Address
First Line : 2920 E CAMELBACK RD STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-4409
Country : US
Telephone Number : 480-999-5666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2017
Last Update Date : 04/15/2025

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