Individual
MR. KEVIN ERNEST MELLENCAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S. LPC
Contact information
Practice address
1320 NW HOMESTEAD DR STE G, LAWTON, OK 73505-5243
(580) 355-8883
(580) 355-8885
Mailing address
1320 NW HOMESTEAD DR STE G, LAWTON, OK 73505-5243
(580) 355-8883
(580) 355-8885
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
4005
OK
Other
Enumeration date
07/28/2010
Last updated
07/28/2010
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