Provider Demographics
NPI:1326353525
Name:POTCHAD, MELISSA P (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:P
Last Name:POTCHAD
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 1:7723 WOODBURY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-6437
Mailing Address - Country:US
Mailing Address - Phone:262-227-9692
Mailing Address - Fax:
Practice Address - Street 1:905 MOUNTAIN LION CIR
Practice Address - Street 2:SUITE 500
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5709
Practice Address - Country:US
Practice Address - Phone:254-213-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst