Provider Demographics
NPI:1548582828
Name:LEWIS, MELODY NAKINA (BA)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:NAKINA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 NE 115TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7646
Mailing Address - Country:US
Mailing Address - Phone:405-887-8238
Mailing Address - Fax:
Practice Address - Street 1:402 NE 115TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-7646
Practice Address - Country:US
Practice Address - Phone:405-887-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor