Provider Demographics
NPI:1598502908
Name:OWENS, MELLISSA ANN (BCBA)
Entity type:Individual
Prefix:
First Name:MELLISSA
Middle Name:ANN
Last Name:OWENS
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 1:1151 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-2940
Mailing Address - Country:US
Mailing Address - Phone:530-838-8141
Mailing Address - Fax:
Practice Address - Street 1:1851 HERITAGE LN STE 260
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4945
Practice Address - Country:US
Practice Address - Phone:530-838-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB589960103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst