Provider Demographics
NPI:1164719274
Name:BAXLEY, MELADIE JO (LPC)
Entity Type:Individual
Prefix:
First Name:MELADIE
Middle Name:JO
Last Name:BAXLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MELADIE
Other - Middle Name:JO
Other - Last Name:HASSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:219 TABOR DR
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-8912
Mailing Address - Country:US
Mailing Address - Phone:405-615-7485
Mailing Address - Fax:
Practice Address - Street 1:804 W CHOCTAW AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018
Practice Address - Country:US
Practice Address - Phone:405-222-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health