Provider Demographics
NPI:1265841712
Name:HODGES, MELISA IX (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:
Last Name:HODGES
Suffix:IX
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 SE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-6704
Mailing Address - Country:US
Mailing Address - Phone:918-810-2071
Mailing Address - Fax:
Practice Address - Street 1:1601 W OKMULGEE ST
Practice Address - Street 2:SUITE M
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6749
Practice Address - Country:US
Practice Address - Phone:918-681-4944
Practice Address - Fax:918-681-4990
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor