Provider Demographics
NPI:1871856328
Name:HEARNE, MELODY LORRAINE
Entity Type:Individual
Prefix:MS
First Name:MELODY
Middle Name:LORRAINE
Last Name:HEARNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-1418
Mailing Address - Country:US
Mailing Address - Phone:405-445-2452
Mailing Address - Fax:
Practice Address - Street 1:1800 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-1418
Practice Address - Country:US
Practice Address - Phone:405-445-2452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health