Provider Demographics
NPI:1821636721
Name:HICKS, MELODY MORGAN (QASP-S)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:MORGAN
Last Name:HICKS
Suffix:
Gender:F
Credentials:QASP-S
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:MORGAN
Other - Last Name:ORNELAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QASP-S
Mailing Address - Street 1:1330 QUAIL LAKE LOOP STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4651
Mailing Address - Country:US
Mailing Address - Phone:719-540-2138
Mailing Address - Fax:
Practice Address - Street 1:1330 QUAIL LAKE LOOP STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4651
Practice Address - Country:US
Practice Address - Phone:719-540-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
13676106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician