Provider Demographics
NPI:1790319812
Name:TURNER, MELISSA ANN (BA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:TURNER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2432
Mailing Address - Country:US
Mailing Address - Phone:918-327-3660
Mailing Address - Fax:
Practice Address - Street 1:11412 N 134TH EAST AVE STE C3
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4969
Practice Address - Country:US
Practice Address - Phone:918-376-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-19-103784106S00000X
OKF083261985103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician