Provider Demographics
NPI:1407866643
Name:ERVIN, MELISSA (BHRS/CMA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:BHRS/CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6128 E 38TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5814
Mailing Address - Country:US
Mailing Address - Phone:918-599-7404
Mailing Address - Fax:
Practice Address - Street 1:6128 E 38TH ST STE 305
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5814
Practice Address - Country:US
Practice Address - Phone:918-599-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKODMHSAS CASE MGR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health