Individual
MS. KELLIE DENISE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC-MH
Contact information
Practice address
4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5104
(405) 424-7711
Mailing address
4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5104
(405) 424-7711
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
1343
OK
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200378690A
—
OK
Enumeration date
03/22/2010
Last updated
11/13/2023
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