Provider Demographics
NPI:1134450646
Name:MELTON, DAROLYN DANAE (MED)
Entity type:Individual
Prefix:
First Name:DAROLYN
Middle Name:DANAE
Last Name:MELTON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LUELLA DR
Mailing Address - Street 2:
Mailing Address - City:CORN
Mailing Address - State:OK
Mailing Address - Zip Code:73024-9241
Mailing Address - Country:US
Mailing Address - Phone:580-330-0619
Mailing Address - Fax:
Practice Address - Street 1:703 FRISCO AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3320
Practice Address - Country:US
Practice Address - Phone:580-323-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health