Provider Demographics
NPI:1740888098
Name:GILL, MELLISSA A (RBT)
Entity type:Individual
Prefix:
First Name:MELLISSA
Middle Name:A
Last Name:GILL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MELLISSA
Other - Middle Name:A
Other - Last Name:GILL-CHANCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:364 SE 37TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6251
Mailing Address - Country:US
Mailing Address - Phone:305-283-6477
Mailing Address - Fax:
Practice Address - Street 1:364 SE 37TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6251
Practice Address - Country:US
Practice Address - Phone:305-283-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL584313103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst