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General NPI Number Information
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NPI Number | 1417244179
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Entity Type | Organization
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Legal Business Name | MELINDA SHAVER, PSY.D.
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 315 N COLLEGE AVE
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City | TAHLEQUAH
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State | OK
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Zip | 74464-2703
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Country | US
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Telephone | 918-457-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 16460 N WOODLAND HILLS LN
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City | HULBERT
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State | OK
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Zip | 74441-2247
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Country | US
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Telephone | 918-457-8100
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Fax | 918-453-1171
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MELINDA ANNE SHAVER
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Credential | PSY.D.
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Telephone | 918-457-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 103TC0700X
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License Number State | OK
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