Organization
MELINDA SHAVER, PSY.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELINDA ANNE SHAVER PSY.D. (PSYCHOLOGIST)
(918) 457-8100
Entity
Organization
Contact information
Practice address
315 N COLLEGE AVE, TAHLEQUAH, OK 74464-2703
(918) 457-8100
Mailing address
16460 N WOODLAND HILLS LN, HULBERT, OK 74441-2247
(918) 457-8100
(918) 453-1171
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
103TC0700X
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427061209
INDIVIDUAL NPI
—
05
—
200092020A
—
OK
Enumeration date
07/01/2011
Last updated
07/01/2011
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