Provider Demographics
NPI:1508183203
Name:ROBINSON, MELISSA JILL (MSPS, LBP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JILL
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MSPS, LBP
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPS, LBP
Mailing Address - Street 1:1201 ARLINGTON ST STE G
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4072
Mailing Address - Country:US
Mailing Address - Phone:580-332-6851
Mailing Address - Fax:580-310-6047
Practice Address - Street 1:1201 ARLINGTON ST STE G
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4072
Practice Address - Country:US
Practice Address - Phone:580-332-6851
Practice Address - Fax:580-310-6047
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health