Provider Demographics
NPI:1033582341
Name:LEE, MELLYSA JAMIE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MELLYSA
Middle Name:JAMIE
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 HAWAII ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1314
Mailing Address - Country:US
Mailing Address - Phone:808-391-1379
Mailing Address - Fax:
Practice Address - Street 1:634 HAWAII ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1314
Practice Address - Country:US
Practice Address - Phone:808-391-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA19103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst