Provider Demographics
NPI:1700482577
Name:DEAN, MELISSA REEDY (MED BCBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:REEDY
Last Name:DEAN
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 S 6TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2510
Mailing Address - Country:US
Mailing Address - Phone:276-782-5976
Mailing Address - Fax:
Practice Address - Street 1:285 S 6TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2510
Practice Address - Country:US
Practice Address - Phone:276-782-5976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-20-46408103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst