Provider Demographics
NPI:1174761597
Name:NEWBURN, MELISSA (BS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:NEWBURN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4431
Mailing Address - Country:US
Mailing Address - Phone:918-682-2491
Mailing Address - Fax:918-682-1480
Practice Address - Street 1:301 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6008
Practice Address - Country:US
Practice Address - Phone:918-682-2491
Practice Address - Fax:918-682-1480
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation