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General NPI Number Information
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NPI Number | 1033241146
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Entity Type | Individual
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Provider Name | SUZANNE MELUGIN MBS
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 134 N 12TH AVE
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City | DURANT
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State | OK
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Zip | 74701-4718
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Country | US
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Telephone | 580-924-6363
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Fax | 580-924-0379
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Provider Business Mailing Address
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Address Line | 1801 W MAIN ST
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City | DURANT
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State | OK
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Zip | 74701-4913
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Country | US
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Telephone | 903-267-3526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4157
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 85739
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License Number State | TX
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