Provider Demographics
NPI:1841910320
Name:FARES, ASIA MELINDA MARIE (RBT)
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:MELINDA MARIE
Last Name:FARES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19635 ROSEBUD PL NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8547
Mailing Address - Country:US
Mailing Address - Phone:224-436-4503
Mailing Address - Fax:
Practice Address - Street 1:5624 STARLING RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73179-2505
Practice Address - Country:US
Practice Address - Phone:224-436-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician