Healthcare Provider Details

I. General information

NPI: 1033783600
Provider Name (Legal Business Name): MELISA TUNLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 NE 28TH ST STE 204
OKLAHOMA CITY OK
73105-2837
US

IV. Provider business mailing address

5300 N MERIDIAN AVE # 11D
OKLAHOMA CITY OK
73112-2179
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-4565
  • Fax:
Mailing address:
  • Phone: 405-281-4854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: