Provider Demographics
NPI:1255537007
Name:BJERKE, MELISSA VERES (LMSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:VERES
Last Name:BJERKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-4438
Mailing Address - Country:US
Mailing Address - Phone:580-338-5730
Mailing Address - Fax:580-338-6115
Practice Address - Street 1:520 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-4438
Practice Address - Country:US
Practice Address - Phone:580-338-5730
Practice Address - Fax:580-338-6115
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33971041C0700X
TX368071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical