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Individual
MRS. KELLY RANAE MOUNCE
Active
Individual
MRS. KELLY RANAE MOUNCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4137
OK
101YP2500X
Professional Counselor
178.009763
IL
101YP2500X
Professional Counselor
4137
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100732910-A
MEDICAID/SOONERCARE GROUP
OK
01
—
73-1042545
COMMUNITY CARE OF OKLAHOMA GROUP
OK
01
—
731042545001
TRICARE GROUP
OK
Enumeration date
08/18/2006
Last updated
09/07/2021
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