Provider Demographics
NPI:1730460999
Name:OLIVER, MELISSA GRACE (MS)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GRACE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-5836
Mailing Address - Country:US
Mailing Address - Phone:405-533-1222
Mailing Address - Fax:405-533-5422
Practice Address - Street 1:1409 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5836
Practice Address - Country:US
Practice Address - Phone:405-533-1222
Practice Address - Fax:405-533-5422
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK1089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor