Provider Demographics
NPI:1679959811
Name:DR. MELINDA SHAVER, L.L.C.
Entity Type:Organization
Organization Name:DR. MELINDA SHAVER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:620-926-1286
Mailing Address - Street 1:201 N PENN AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3357
Mailing Address - Country:US
Mailing Address - Phone:620-926-1286
Mailing Address - Fax:
Practice Address - Street 1:201 N PENN AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3357
Practice Address - Country:US
Practice Address - Phone:620-926-1286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2326251S00000X
OK962251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201124310AMedicaid
OK239713108Medicare PIN