Provider Demographics
NPI:1467866764
Name:COOKS, MELANIE JANIECE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JANIECE
Last Name:COOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 NW 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-5005
Mailing Address - Country:US
Mailing Address - Phone:405-607-2877
Mailing Address - Fax:405-418-4041
Practice Address - Street 1:1325 NW 103RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-5005
Practice Address - Country:US
Practice Address - Phone:405-607-2877
Practice Address - Fax:405-418-4041
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health