Individual
KELLI BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19600 E ROSS ST, TAHLEQUAH, OK 74464-0545
(539) 234-1000
Mailing address
619 N MAIN ST, MUSKOGEE, OK 74401-4431
(918) 682-8407
(918) 687-0976
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100734050
—
OK
Enumeration date
11/08/2010
Last updated
06/25/2021
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