Provider Demographics
NPI:1508018144
Name:BORLIE, MELISSA ANNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANNE
Last Name:BORLIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10311 E 25TH PLACE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-7419
Mailing Address - Country:US
Mailing Address - Phone:918-850-2903
Mailing Address - Fax:918-660-7610
Practice Address - Street 1:10311 E 25TH PLACE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-7419
Practice Address - Country:US
Practice Address - Phone:918-850-2903
Practice Address - Fax:918-660-7610
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4212101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional