Individual
MELISA JO GOLDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
504 E 24TH ST, TISHOMINGO, OK 73460-3214
(580) 371-9933
(580) 371-9944
Mailing address
504 E 24TH STREET, TISHOMINGO, OK 73460
(580) 371-9933
(580) 371-9944
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200443090A
—
OK
Enumeration date
11/05/2012
Last updated
11/05/2012
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