Provider Demographics
NPI:1508678780
Name:MELTON, AVIA (RBT)
Entity type:Individual
Prefix:
First Name:AVIA
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 COUNTY ROAD 231
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-7117
Mailing Address - Country:US
Mailing Address - Phone:346-464-9188
Mailing Address - Fax:
Practice Address - Street 1:222 COUNTY ROAD 231
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-7117
Practice Address - Country:US
Practice Address - Phone:346-464-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22-210453106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician