Healthcare Provider Details

I. General information

NPI: 1578899019
Provider Name (Legal Business Name): MELLANY ANN PAINTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELLANY ANN NOWLIN LPC

II. Dates (important events)

Enumeration Date: 10/18/2009
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600-1602 N D ST
MCALESTER OK
74501
US

IV. Provider business mailing address

PO BOX 1710
KINGSTON OK
73439
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-1614
  • Fax: 918-426-1648
Mailing address:
  • Phone: 918-426-1614
  • Fax: 918-426-1648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3133
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: