Provider Demographics
NPI:1477275972
Name:MELTON-WILLIAMS, ADRIAN JADE
Entity Type:Individual
Prefix:MRS
First Name:ADRIAN
Middle Name:JADE
Last Name:MELTON-WILLIAMS
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 1:1722 S CARSON AVE
Mailing Address - Street 2:APT 907
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-2205
Mailing Address - Country:US
Mailing Address - Phone:580-743-7069
Mailing Address - Fax:
Practice Address - Street 1:1722 S CARSON AVE
Practice Address - Street 2:APT 907
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-7411
Practice Address - Country:US
Practice Address - Phone:580-743-7069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKBACB770606106S00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician