Provider Demographics
NPI:1801182399
Name:MELSH, STEPHEN ANDRUS (MSPS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ANDRUS
Last Name:MELSH
Suffix:
Gender:M
Credentials:MSPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 LARISSA LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6162
Mailing Address - Country:US
Mailing Address - Phone:405-947-8355
Mailing Address - Fax:
Practice Address - Street 1:4701 LARISSA LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6162
Practice Address - Country:US
Practice Address - Phone:405-947-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health