Basic Information
| Provider Information | |||||||||
| NPI: | 1275900466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MELISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17897 TALL OAK RD | ||||||||
| Address2: | |||||||||
| City: | CHOCTAW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730206943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054106210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 UNITED FOUNDERS BLVD STE 239 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058407040 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2015 | ||||||||
| LastUpdateDate: | 02/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.