Provider Demographics
NPI:1427491836
Name:POIST, MELINDA (BCBA)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:POIST
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3804
Mailing Address - Country:US
Mailing Address - Phone:937-878-4614
Mailing Address - Fax:937-878-4719
Practice Address - Street 1:919 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3804
Practice Address - Country:US
Practice Address - Phone:937-878-4614
Practice Address - Fax:937-878-4719
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-12-12188103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst