Provider Demographics
NPI:1497726954
Name:COTTRELL, MELISSA LEA (CNS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEA
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:HEDINGER
Other - Last Name:COTTRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPARTMENT 31
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-491-3702
Mailing Address - Fax:918-491-5740
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-491-3702
Practice Address - Fax:918-491-5740
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0037482364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100124810AMedicaid
2014553OtherCIGNA BEHAVIORAL HEALTH
OKP40073Medicare UPIN