Individual provider Active NPI

Melana Ivie

  • Professional Counselor
  • Broken Arrow, OK
National Provider Identifier
1285154377
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
10251 Issued in OK
Practice address
4416 W Houston St
Broken Arrow, OK 74012-4645
Phone
(918) 288-0027
NPI assigned
Jun 21, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Professional Counselor 101YP2500X 10251 OK Primary
Mental Health Counselor 101YM0800X 10251 OK

Addresses

Primary practice location

4416 W Houston St
Broken Arrow, OK 74012-4645

Mailing address

4416 W Houston St
Broken Arrow, OK 74012-4645
Phone (918) 728-4760

Other practice location 1

324 E Chestnut St
Coweta, OK 74429-2532
Phone (918) 279-6565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250107002036 OK Practitioner - Mental Health Counselor 4981132768 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10251OKMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Halls Anchor of Hope Mental Health CurrentSince Nov 2, 2024 Accepting new patients
Melton Health and Medical Services Past Accepting new patients

Locations

2141 W Concord Cir
Broken Arrow, OK 74012
Phone (918) 288-0027

4416 W Houston St
Broken Arrow, OK 74012
Phone (918) 288-0027

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1285154377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4416 W HOUSTON ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740124645",
            "telephone_number": "918-728-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4416 W HOUSTON ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740124645",
            "telephone_number": "918-288-0027"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "324 E Chestnut St",
            "address_purpose": "LOCATION",
            "city": "Coweta",
            "state": "OK",
            "postal_code": "744292532",
            "country_code": "US",
            "telephone_number": "918-279-6565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IVIE",
        "first_name": "MELANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "10251",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "10251",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.