Provider Demographics
NPI:1104259670
Name:TSACLAS, MELINDA JOY (MS, BCBA)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:JOY
Last Name:TSACLAS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59-065 PAUMALU PL
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-9751
Mailing Address - Country:US
Mailing Address - Phone:516-567-7037
Mailing Address - Fax:
Practice Address - Street 1:59-065 PAUMALU PL
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-9751
Practice Address - Country:US
Practice Address - Phone:516-567-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-13-14076103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst