1578899019 NPI number — MRS. MELLANY ANN PAINTER LPC

Table of content: MRS. MELLANY ANN PAINTER LPC (NPI 1578899019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578899019 NPI number — MRS. MELLANY ANN PAINTER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAINTER
Provider First Name:
MELLANY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOWLIN
Provider Other First Name:
MELLANY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578899019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1710
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-426-1614
Provider Business Mailing Address Fax Number:
918-426-1648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600-1602 N D ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALESTER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-426-1614
Provider Business Practice Location Address Fax Number:
918-426-1648
Provider Enumeration Date:
10/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  3133 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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