Provider Demographics
NPI:1376300715
Name:MELHORN, KELLY (BCABA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MELHORN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 RIVA RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7452
Mailing Address - Country:US
Mailing Address - Phone:763-548-4296
Mailing Address - Fax:
Practice Address - Street 1:180 RIVA RIDGE PL
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7452
Practice Address - Country:US
Practice Address - Phone:763-548-4296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst