Individual
CAROLYN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3445 S SHERIDAN RD, TULSA, OK 74145-1105
(918) 610-3366
Mailing address
3445 S SHERIDAN RD, TULSA, OK 74145-1105
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
437
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-IND
1-IND
—
Enumeration date
03/13/2019
Last updated
06/11/2019
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