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General NPI Number Information
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NPI Number | 1477868594
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Entity Type | Organization
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Legal Business Name | J MELTON LLC
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 110 W MAIN ST
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City | HOLDENVILLE
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State | OK
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Zip | 74848-3230
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Country | US
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Telephone | 405-221-2610
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 186
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City | HOLDENVILLE
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State | OK
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Zip | 74848-0186
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Country | US
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Telephone | 405-221-2610
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JUNE MELTON
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Credential | LPC
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Telephone | 405-221-2610
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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 | 2340
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License Number State | OK
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