Individual
MISTYE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
716 SW 1ST ST, MOORE, OK 73160-2301
(405) 735-7786
Mailing address
716 SW 1ST ST, MOORE, OK 73160-2301
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/02/2013
Last updated
05/08/2016
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