Provider Demographics
NPI:1033241146
Name:MELUGIN, SUZANNE (MBS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MELUGIN
Suffix:
Gender:F
Credentials:MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-4913
Mailing Address - Country:US
Mailing Address - Phone:903-267-3526
Mailing Address - Fax:
Practice Address - Street 1:134 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4718
Practice Address - Country:US
Practice Address - Phone:580-924-6363
Practice Address - Fax:580-924-0379
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK4157101YP2500X
TX85739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor