Provider Demographics
NPI:1578899019
Name:PAINTER, MELLANY ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELLANY
Middle Name:ANN
Last Name:PAINTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MELLANY
Other - Middle Name:ANN
Other - Last Name:NOWLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439
Mailing Address - Country:US
Mailing Address - Phone:918-426-1614
Mailing Address - Fax:918-426-1648
Practice Address - Street 1:1600-1602 N D ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-426-1614
Practice Address - Fax:918-426-1648
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3133101YP2500X
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional