Provider Demographics
NPI:1760845218
Name:MERLY MATHEW, LLC
Entity Type:Organization
Organization Name:MERLY MATHEW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-242-6460
Mailing Address - Street 1:3035 NW 63RD ST
Mailing Address - Street 2:SUITE 227
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3632
Mailing Address - Country:US
Mailing Address - Phone:405-242-6460
Mailing Address - Fax:405-212-4463
Practice Address - Street 1:3035 NW 63RD ST
Practice Address - Street 2:SUITE 227
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3631
Practice Address - Country:US
Practice Address - Phone:405-242-6460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1224103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty