Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1174761597 |
---|---|
Provider Name | Melissa Newburn |
First Address | Muskogee, OK 74401-4431 |
Second Address | Muskogee, OK 74401-6008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2009 |
Last Update Date | 22/01/2009 |