Individual
MS. KELLY RAE DUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
6355 S 80TH EAST AVE APT K, TULSA, OK 74133-3813
(918) 902-1170
Mailing address
6355 S 80TH EAST AVE APT K, TULSA, OK 74133-3813
(918) 902-1170
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
14397
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14397
OKLAHOMA CADC
OK
Enumeration date
04/30/2010
Last updated
04/30/2010
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