Individual
MELISSA PROVENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 E LINCOLN RD, IDABEL, OK 74745-7353
(580) 286-6639
Mailing address
PO BOX 579, MCALESTER, OK 74502-0579
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/28/2021
Last updated
04/28/2021
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