Provider Demographics
NPI:1609764471
Name:VENABLE, MELISSA S (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:VENABLE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 E JAMESTOWN DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2018
Mailing Address - Country:US
Mailing Address - Phone:417-812-9717
Mailing Address - Fax:
Practice Address - Street 1:7733 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5518
Practice Address - Country:US
Practice Address - Phone:801-885-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14230693-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst