Provider Demographics
NPI:1174647358
Name:ANTHONY, MELINDA SUE (BS, CM, BHRS)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:SUE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:BS, CM, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 W CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:STROUD
Mailing Address - State:OK
Mailing Address - Zip Code:74079-3819
Mailing Address - Country:US
Mailing Address - Phone:918-306-2287
Mailing Address - Fax:918-382-1242
Practice Address - Street 1:550 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3820
Practice Address - Country:US
Practice Address - Phone:918-306-2287
Practice Address - Fax:918-382-1242
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator