Provider Demographics
NPI:1245722446
Name:PRICE, MELISSA (MARI, BCBA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:MARI, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2222
Mailing Address - Country:US
Mailing Address - Phone:630-730-1538
Mailing Address - Fax:
Practice Address - Street 1:522 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1839
Practice Address - Country:US
Practice Address - Phone:847-271-3264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-17-28347103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst