Provider Demographics
NPI:1194962720
Name:LEEDY, MELISSA JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JEAN
Last Name:LEEDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035A WEST HOUSTON STREET
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8792
Mailing Address - Country:US
Mailing Address - Phone:918-505-4367
Mailing Address - Fax:888-371-9410
Practice Address - Street 1:2035A WEST HOUSTON STREET
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8792
Practice Address - Country:US
Practice Address - Phone:918-505-4367
Practice Address - Fax:888-371-9410
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7846103T00000X
OK1268103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist