Provider Demographics
NPI:1073550067
Name:MEASHINTUBBY, NELLIE M (LPC,LADC)
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:M
Last Name:MEASHINTUBBY
Suffix:
Gender:F
Credentials:LPC,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-0753
Mailing Address - Country:US
Mailing Address - Phone:918-420-5238
Mailing Address - Fax:918-420-5717
Practice Address - Street 1:400 E WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5464
Practice Address - Country:US
Practice Address - Phone:918-420-5238
Practice Address - Fax:918-420-5717
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK147101YA0400X
OK2313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health