Individual
JENNIFER ANN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS LPC
Contact information
Practice address
1900 N MACARTHUR BLVD, SUITE 105, OKLAHOMA CITY, OK 73127-2617
(405) 640-1973
Mailing address
1424 CHIMNEY HILL RD, YUKON, OK 73099-3107
(405) 640-1973
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10
BEHAVIORAL HEALTH AND SOC
OK
Enumeration date
06/26/2007
Last updated
06/27/2011
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