Provider Demographics
NPI:1134505191
Name:NGUYEN, MELANIE REBECCA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:REBECCA
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:REBECCA
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1744 W HORIZON RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4833
Mailing Address - Country:US
Mailing Address - Phone:702-742-3093
Mailing Address - Fax:
Practice Address - Street 1:1744 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4833
Practice Address - Country:US
Practice Address - Phone:702-742-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CORBT-15-01693247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other