Provider Demographics
NPI:1679634604
Name:RICH, MELISSA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:R
Last Name:RICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E 15TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5043
Mailing Address - Country:US
Mailing Address - Phone:405-341-1727
Mailing Address - Fax:405-226-9894
Practice Address - Street 1:1401 E I 44 SERVICE RD STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-7400
Practice Address - Country:US
Practice Address - Phone:405-341-1727
Practice Address - Fax:405-286-9894
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist