Provider Demographics
NPI:1114298486
Name:BOLDING, MELANIE ANN (BS IN EDUACATION)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ANN
Last Name:BOLDING
Suffix:
Gender:F
Credentials:BS IN EDUACATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12143 HIGHWAY 82A
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6274
Mailing Address - Country:US
Mailing Address - Phone:918-456-2884
Mailing Address - Fax:
Practice Address - Street 1:12143 HIGHWAY 82A
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-6274
Practice Address - Country:US
Practice Address - Phone:918-456-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst