Provider Demographics
NPI:1063877405
Name:MCCULLY, KELSEY (LPC-CAN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MCCULLY
Suffix:
Gender:F
Credentials:LPC-CAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 24TH AVE SE
Mailing Address - Street 2:APT 3
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-1796
Mailing Address - Country:US
Mailing Address - Phone:918-696-1783
Mailing Address - Fax:
Practice Address - Street 1:4117 24TH AVE SE
Practice Address - Street 2:APT 3
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-1796
Practice Address - Country:US
Practice Address - Phone:918-696-1783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health