Provider Demographics
NPI:1326600982
Name:ELDER, MELISSA R (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:R
Last Name:ELDER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 30589
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73140
Mailing Address - Country:US
Mailing Address - Phone:405-769-3301
Mailing Address - Fax:405-769-3301
Practice Address - Street 1:130 N BROADWAY AVE STE 300
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6939
Practice Address - Country:US
Practice Address - Phone:405-395-0399
Practice Address - Fax:405-395-0330
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical