Healthcare Provider Details

I. General information

NPI: 1073711990
Provider Name (Legal Business Name): MELANIE LOCK SMITH MS LBP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE DENISE LOCK MS LBP

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 12/04/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 E ALMAR
CHICKASHA OK
73018
US

IV. Provider business mailing address

198 E ALMAR
CHICKASHA OK
73018
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-5437
  • Fax: 405-222-5441
Mailing address:
  • Phone: 405-222-5437
  • Fax: 405-222-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number168
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: