Provider Demographics
NPI:1356734610
Name:A NEW SISTAHOOD ASSOCIATION
Entity type:Organization
Organization Name:A NEW SISTAHOOD ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:405-430-5476
Mailing Address - Street 1:1333 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-5137
Mailing Address - Country:US
Mailing Address - Phone:405-430-5476
Mailing Address - Fax:
Practice Address - Street 1:1333 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-5137
Practice Address - Country:US
Practice Address - Phone:405-430-5476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 390200000X
OK378444170200251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or CharitableGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty