Provider Demographics
NPI:1720826944
Name:MARTIN, MELISSA TICE (BACB)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:TICE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BACB
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:ANN TICE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:27 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-9575
Mailing Address - Country:US
Mailing Address - Phone:302-245-9262
Mailing Address - Fax:
Practice Address - Street 1:27 LIGHTHOUSE DR
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-9575
Practice Address - Country:US
Practice Address - Phone:302-245-9262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst