Provider Demographics
NPI:1932629391
Name:CONTI, MELODIE LYNN (RBT)
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:LYNN
Last Name:CONTI
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 1:146 RAINBOW DR NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4329
Mailing Address - Country:US
Mailing Address - Phone:850-637-2657
Mailing Address - Fax:
Practice Address - Street 1:116 4TH ST SE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5425
Practice Address - Country:US
Practice Address - Phone:850-368-9373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-35935106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician