Provider Demographics
NPI:1639362452
Name:MAURER ELLZY, MELISSA ANN (BSSW, MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:MAURER ELLZY
Suffix:
Gender:F
Credentials:BSSW, MA, BCBA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:MAURER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSSW, MA, BCBA
Mailing Address - Street 1:231 GARDENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-4029
Mailing Address - Country:US
Mailing Address - Phone:615-480-1184
Mailing Address - Fax:615-373-7512
Practice Address - Street 1:231 GARDENRIDGE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-4029
Practice Address - Country:US
Practice Address - Phone:615-480-1184
Practice Address - Fax:615-373-7512
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518659Medicaid