Provider Demographics
NPI:1053850693
Name:PERRYMAN, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PERRYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24797 S HIGHWAY 66 UNIT 5
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-2402
Mailing Address - Country:US
Mailing Address - Phone:918-342-2080
Mailing Address - Fax:918-342-0075
Practice Address - Street 1:24797 S HIGHWAY 66 UNIT 5
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-2402
Practice Address - Country:US
Practice Address - Phone:918-342-2080
Practice Address - Fax:918-342-0075
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor