Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0076 | OK |
NPI | 1003147414 |
---|---|
Provider Name | Melissa Holaday |
First Address | Durant, OK 74701-3801 |
Second Address | Durant, OK 74701-3801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2010 |
Last Update Date | 25/01/2010 |