Provider Demographics
NPI:1659720597
Name:O'HAIR, MELINDA
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:O'HAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 AVENUE P
Mailing Address - Street 2:SUITE B
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7032
Mailing Address - Country:US
Mailing Address - Phone:620-225-1442
Mailing Address - Fax:620-225-1709
Practice Address - Street 1:1509 AVENUE P
Practice Address - Street 2:SUITE B
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7032
Practice Address - Country:US
Practice Address - Phone:620-225-1442
Practice Address - Fax:620-225-1709
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS99981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical