Doctor Name: | MR. KEVIN ERNEST MELLENCAMP |
NPI Number: | 1033423389 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S. LPC |
License Number: | 4005 |
Business Practice Address: | 1320 Nw Homestead Dr Ste G Lawton, OK - 735055243 |
Business Phone Number: | 5803558883 |
Business Fax Number: | 5803558885 |
Mailing Address: | 1320 Nw Homestead Dr Ste G, LAWTON |
State: | OK |
Postal Code: | 735055243 |
Phone Number: | 5803558883 |
Fax Number: | 5803558885 |
NPI Enumeration Date: | 07/28/2010 |
NPI Last Update Date: | 07/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 4005 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |