Provider Demographics
NPI:1538740451
Name:KELLEY, KEELY (MS, NCC)
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 BATTLES RD
Mailing Address - Street 2:
Mailing Address - City:KIOWA
Mailing Address - State:OK
Mailing Address - Zip Code:74553-5096
Mailing Address - Country:US
Mailing Address - Phone:918-916-2411
Mailing Address - Fax:
Practice Address - Street 1:104 E CARL ALBERT PKWY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5092
Practice Address - Country:US
Practice Address - Phone:918-423-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health