Individual
KELLY MCCANNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LBP
Contact information
Practice address
602 SW 38TH ST, LAWTON, OK 73505-6912
(580) 248-5436
(580) 248-9128
Mailing address
602 SW 38TH ST, LAWTON, OK 73505-6912
(580) 248-5436
(580) 248-9128
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0337
OK
Other
Enumeration date
06/25/2007
Last updated
07/08/2007
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