Provider Demographics
NPI:1568029452
Name:WHITE, MELISSA RALEY (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RALEY
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8314
Mailing Address - Country:US
Mailing Address - Phone:859-796-2525
Mailing Address - Fax:985-288-5360
Practice Address - Street 1:1670 OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8314
Practice Address - Country:US
Practice Address - Phone:985-796-2525
Practice Address - Fax:985-288-5360
Is Sole Proprietor?:No
Enumeration Date:2019-05-25
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-374103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst