Provider Demographics
NPI:1902695620
Name:METHVIN, CARTER MARK
Entity type:Individual
Prefix:
First Name:CARTER
Middle Name:MARK
Last Name:METHVIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 HASLEY DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4916
Mailing Address - Country:US
Mailing Address - Phone:405-620-7012
Mailing Address - Fax:
Practice Address - Street 1:2008 HASLEY DR
Practice Address - Street 2:
Practice Address - City:THE VILLAGE
Practice Address - State:OK
Practice Address - Zip Code:73120-4916
Practice Address - Country:US
Practice Address - Phone:405-620-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health