Provider Demographics
NPI:1053309708
Name:VAN KIRK, MELISSA N (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:N
Last Name:VAN KIRK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4350
Mailing Address - Country:US
Mailing Address - Phone:405-533-1141
Mailing Address - Fax:405-338-7999
Practice Address - Street 1:807 S PINE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4350
Practice Address - Country:US
Practice Address - Phone:405-533-1141
Practice Address - Fax:405-338-7999
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1140103TC0700X
NC3049103TC0700X
KS1938103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2492773Medicare ID - Type Unspecified