MEDICARE: MELISSA EVANS LMSW US LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3852	OK

General Provider Information

NPI Number	:	1497036313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA EVANS LMSW US LCSW

Provider Business Mailing Address
First Line	:	4101 PERIMETER CENTER DR
Second Line	:	STE #250
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2302
Country	:	US
Telephone Number	:	405-751-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 PERIMETER CENTER DR
Second Line	:	STE #250
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2302
Country	:	US
Telephone Number	:	405-751-0800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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