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General NPI Number Information
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NPI Number | 1033354451
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Entity Type | Individual
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Provider Name | MELTON LEE MARTIN L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 12/15/2008
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Provider Practice Location Address
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Address Line | 1612 S CINCINNATI AVE
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City | TULSA
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State | OK
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Zip | 74119-4418
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Country | US
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Telephone | 918-381-3859
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Fax | 918-289-0248
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Provider Business Mailing Address
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Address Line | 3609 E 56TH ST
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City | TULSA
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State | OK
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Zip | 74135-3820
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Country | US
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Telephone | 918-381-3859
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Fax | 918-289-0248
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1799
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License Number State | OK
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