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NPI Code Detail

MEDICARE: MELISSA AMBER GRAHAM MA, BCBA

MEDICARE: MELISSA AMBER GRAHAM MA, 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
1103K00000XBehavior Analyst1-14-17390IN

General Provider Information

NPI Number : 1811385644
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA AMBER GRAHAM MA, BCBA
Provider Business Mailing Address
First Line : 612 E BOULEVARD
Second Line :
City : KOKOMO
State : IN
Zip : 46902-2271
Country : US
Telephone Number : 765-461-1245
Fax Number :
Provider Business Practice Location Address
First Line : 1714 W ROYALE DR
Second Line :
City : MUNCIE
State : IN
Zip : 47304-2240
Country : US
Telephone Number : 765-587-4895
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/01/2015
Last Update Date : 06/05/2019

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