Organization Name: | MELTON HEALTH AND MEDICAL SERVICES |
NPI Number: | 1093123101 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EDWARD GERARD MELTON (CEO) |
Mailing Address: | 1129 S Aspen Ave Broken Arrow |
State: | OK US |
Postal Code: | 740124859 |
Phone Number: | 9187649300 |
Fax Number: | 9187649275 |
NPI Enumeration Date: | 08/01/2014 |
NPI Last Update Date: | 08/01/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |