Provider Demographics
NPI:1659528834
Name:TALLEY, MELANIE CAMILLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:CAMILLE
Last Name:TALLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 NW 122ND ST
Mailing Address - Street 2:STE A1
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8869
Mailing Address - Country:US
Mailing Address - Phone:405-562-9260
Mailing Address - Fax:405-260-9559
Practice Address - Street 1:4117 NW 122ND ST
Practice Address - Street 2:STE A1
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8869
Practice Address - Country:US
Practice Address - Phone:405-562-9260
Practice Address - Fax:405-260-9559
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy