Provider Demographics
NPI:1568718666
Name:KING, MELISSA LYNNE (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNNE
Last Name:KING
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MOSSY BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2638
Mailing Address - Country:US
Mailing Address - Phone:314-406-6075
Mailing Address - Fax:
Practice Address - Street 1:670 MOSSY BRANCH CT
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2638
Practice Address - Country:US
Practice Address - Phone:314-406-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015031167103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst