Provider Demographics
NPI:1518190321
Name:HOLT, MELISSA DEE (MED LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DEE
Last Name:HOLT
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 HWY 70 N
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-8253
Mailing Address - Country:US
Mailing Address - Phone:580-564-7308
Mailing Address - Fax:580-564-8309
Practice Address - Street 1:413 HWY 70 N
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-8253
Practice Address - Country:US
Practice Address - Phone:580-564-7308
Practice Address - Fax:580-564-8309
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health