Provider Demographics
NPI:1316392558
Name:HANCOCK, MELISSA ANN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1111 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4138
Mailing Address - Country:US
Mailing Address - Phone:949-910-6676
Mailing Address - Fax:877-268-3922
Practice Address - Street 1:1111 BAKER ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4138
Practice Address - Country:US
Practice Address - Phone:949-910-6676
Practice Address - Fax:877-268-3922
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-22083103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst