Provider Demographics
NPI:1164716965
Name:MCQUIDDY, MELANIE ERICA
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ERICA
Last Name:MCQUIDDY
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 1:5800 E SKELLY DR STE 1111
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6448
Mailing Address - Country:US
Mailing Address - Phone:918-631-7581
Mailing Address - Fax:
Practice Address - Street 1:5800 E SKELLY DR STE 1111
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-631-7581
Practice Address - Fax:918-209-5538
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1196103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist