Individual
EPHRAIM KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2800 N. ROCKWELL AVE., BETHANY, OK 73008
(405) 933-4581
Mailing address
2800 N. ROCKWELL AVE., BETHANY, OK 73008
(405) 933-4581
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C081932107
OK
Other
Enumeration date
04/29/2014
Last updated
04/29/2014
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