Individual
MRS. CARISSA NICOLE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2215 W. WRANGLER BLVD. APT. 135, SEMINOLE, OK 74868
(405) 584-1350
Mailing address
2215 W WRANGLER BLVD APT 135, SEMINOLE, OK 74868-2098
(405) 584-1350
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/19/2015
Last updated
11/19/2015
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