Provider Demographics
NPI:1386101624
Name:BECK, KELLY S
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 N BROOKLINE AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4286
Mailing Address - Country:US
Mailing Address - Phone:405-810-0054
Mailing Address - Fax:405-810-8977
Practice Address - Street 1:722 E INDEPENDENCE ST STE I
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4037
Practice Address - Country:US
Practice Address - Phone:405-810-0054
Practice Address - Fax:405-810-8977
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor