Provider Demographics
NPI:1407087190
Name:BIRD, MELINDA (BCBA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:BIRD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 HOLSUM CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5901
Mailing Address - Country:US
Mailing Address - Phone:903-288-1778
Mailing Address - Fax:972-584-6117
Practice Address - Street 1:2318 HOLSUM CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5901
Practice Address - Country:US
Practice Address - Phone:903-288-1778
Practice Address - Fax:972-584-6117
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-18258103K00000X
385H00000X, 385HR2060X, 253Z00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No253Z00000XAgenciesIn Home Supportive Care