Healthcare Provider Details

I. General information

NPI: 1275900466
Provider Name (Legal Business Name): MELISSA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 UNITED FOUNDERS BLVD STE 239
OKLAHOMA CITY OK
73112-4294
US

IV. Provider business mailing address

17897 TALL OAK RD
CHOCTAW OK
73020-6943
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-7040
  • Fax:
Mailing address:
  • Phone: 405-410-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: