Provider Demographics
NPI:1972759520
Name:RICHARDS, MELISSA JEANNE (BCBA)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JEANNE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 HICKORY HILL LN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1930
Mailing Address - Country:US
Mailing Address - Phone:615-902-0950
Mailing Address - Fax:615-902-0951
Practice Address - Street 1:1004 HICKORY HILL LN
Practice Address - Street 2:SUITE 4
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1930
Practice Address - Country:US
Practice Address - Phone:615-902-0950
Practice Address - Fax:615-902-0951
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
1-05-2414103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516432Medicaid