Individual
MELANA IVIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4416 W HOUSTON ST, BROKEN ARROW, OK 74012-4645
(918) 288-0027
Mailing address
4416 W HOUSTON ST, BROKEN ARROW, OK 74012-4645
(918) 728-4760
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
10251
OK
101YP2500X
Professional Counselor
Primary
10251
OK
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
06/21/2017
Last updated
08/23/2024
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