Healthcare Provider Details

I. General information

NPI: 1346517273
Provider Name (Legal Business Name): MELODY L MAHONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W A ST
WATONGA OK
73772-4208
US

IV. Provider business mailing address

PO BOX 221
GEARY OK
73040-0221
US

V. Phone/Fax

Practice location:
  • Phone: 580-623-7199
  • Fax: 580-623-7188
Mailing address:
  • Phone: 580-623-7199
  • Fax: 580-623-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: