Provider Demographics
NPI:1639656416
Name:KRANNING, MELISSA MARIE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:KRANNING
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 1:3615 HIGHCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2419
Mailing Address - Country:US
Mailing Address - Phone:804-896-3667
Mailing Address - Fax:
Practice Address - Street 1:502 E RAMSEY RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4639
Practice Address - Country:US
Practice Address - Phone:210-490-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1829103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty