Provider Demographics
NPI:1053559807
Name:MCKINLEY, MELANIE ANN (LCSW, BHCMIII)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANN
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:LCSW, BHCMIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2834 COUNTY STREET 2791
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-8144
Mailing Address - Country:US
Mailing Address - Phone:405-320-0530
Mailing Address - Fax:
Practice Address - Street 1:102 E ALMAR DR
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-7327
Practice Address - Country:US
Practice Address - Phone:405-320-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200415240AMedicaid