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Individual

MRS. KELLY RANAE MOUNCE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, LPC

Contact information

Practice address
550 S PEORIA AVE, TULSA, OK 74120-3820
(918) 382-2205
Mailing address
11670 GUN SMOKE DR, COLLINSVILLE, OK 74021-6437
(918) 231-2500

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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