Individual
MRS. MELISHA KANISH FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS. LPC.
Contact information
Practice address
1013 E 66TH PL, TULSA, OK 74136-3701
(918) 293-2500
(918) 293-2581
Mailing address
5109 S MADISON AVE, APARTMENT 146, TULSA, OK 74105-5682
(918) 856-1915
(918) 293-2581
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/11/2013
Last updated
08/11/2014
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