Provider Demographics
NPI:1932672078
Name:CLEM, MELISSA DAWN (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DAWN
Last Name:CLEM
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:DAWN
Other - Last Name:HISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 NE F ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-2606
Mailing Address - Country:US
Mailing Address - Phone:580-271-1039
Mailing Address - Fax:
Practice Address - Street 1:301 N HIGH ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2238
Practice Address - Country:US
Practice Address - Phone:580-271-7055
Practice Address - Fax:580-271-7056
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator