Provider Demographics
NPI:1972733715
Name:KELLEY, JOY LYN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:LYN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17508 ZINC
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7016
Mailing Address - Country:US
Mailing Address - Phone:405-285-8901
Mailing Address - Fax:
Practice Address - Street 1:17508 ZINC
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-7016
Practice Address - Country:US
Practice Address - Phone:405-285-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKELIGIBLE103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical