Provider Demographics
NPI:1700130218
Name:ALLEN, MELISSA A (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 WILSON STREET, ROOM 3E166
Mailing Address - Street 2:REYNOLDS ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-9042
Mailing Address - Country:US
Mailing Address - Phone:580-558-2200
Mailing Address - Fax:580-558-2314
Practice Address - Street 1:4301 WILSON STREET, ROOM 3E166
Practice Address - Street 2:REYNOLDS ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-9042
Practice Address - Country:US
Practice Address - Phone:580-558-2200
Practice Address - Fax:580-558-2314
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical