Provider Demographics
NPI:1821456302
Name:PATTERSON-BOLLES, MELISSA JANE (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JANE
Last Name:PATTERSON-BOLLES
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:PATTERSON-BOLLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:2310 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2761
Mailing Address - Country:US
Mailing Address - Phone:918-913-4464
Mailing Address - Fax:
Practice Address - Street 1:2310 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-913-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor