Individual
MELISSA GANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
102 N ELM PL STE N, BROKEN ARROW, OK 74012-3883
(918) 760-8155
Mailing address
2928 N FERN CT, BROKEN ARROW, OK 74012-0834
(918) 760-8155
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2715
OK
Other
Enumeration date
02/10/2012
Last updated
04/03/2024
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