Individual
KEENAN MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1310 E 54TH ST N, TULSA, OK 74126-2813
(918) 863-6500
Mailing address
1310 E 54TH ST N, TULSA, OK 74126-2813
(918) 863-6500
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000000000000000
—
OK
Enumeration date
10/05/2016
Last updated
10/05/2016
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