1639362452 NPI number — MELISSA ANN MAURER ELLZY BSSW, MA, BCBA

Table of content: MELISSA ANN MAURER ELLZY BSSW, MA, BCBA (NPI 1639362452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639362452 NPI number — MELISSA ANN MAURER ELLZY BSSW, MA, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAURER ELLZY
Provider First Name:
MELISSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSSW, MA, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAURER
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSSW, MA, BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639362452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
231 GARDENRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37069-4029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-480-1184
Provider Business Mailing Address Fax Number:
615-373-7512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 GARDENRIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37069-4029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-480-1184
Provider Business Practice Location Address Fax Number:
615-373-7512
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1518659 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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