Provider Demographics
NPI:1679979314
Name:COLBERT, MELISSA KAY (MED; BCBA; LBA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:COLBERT
Suffix:
Gender:F
Credentials:MED; BCBA; LBA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:SCHOLLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED; BCBA; LBA
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:3403B GARDEN VILLA LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6915
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
TX1-17-26721103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other