Individual
MELISSA SOUTHALL BROOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2222 S FRONTAGE RD, VICKSBURG, MS 39180-5271
(601) 852-3271
Mailing address
2222 S FRONTAGE RD, VICKSBURG, MS 39180-5271
(601) 218-5497
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
220005
MS
Other
Enumeration date
09/03/2019
Last updated
01/24/2022
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