Individual
MRS. MELLISSA GAYE HUMPHREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6202 S LEWIS AVE, TULSA, OK 74136-1099
(405) 555-1212
Mailing address
PO BOX 203, LANE, OK 74555-0203
(405) 555-1212
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
12/11/2012
Last updated
12/11/2012
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