Provider Demographics
NPI:1831401009
Name:MATHEW, MERLY (PHD)
Entity type:Individual
Prefix:DR
First Name:MERLY
Middle Name:
Last Name:MATHEW
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 1:3035 NW 63RD ST
Mailing Address - Street 2:227
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3632
Mailing Address - Country:US
Mailing Address - Phone:405-849-6173
Mailing Address - Fax:405-544-5916
Practice Address - Street 1:3035 NW 63RD ST
Practice Address - Street 2:227
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3632
Practice Address - Country:US
Practice Address - Phone:405-849-6173
Practice Address - Fax:405-544-5916
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1224103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist