Individual
MARCUS JEROME KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1805 MEAD LN, MOORE, OK 73170-1472
(405) 201-8496
Mailing address
1805 MEAD LN, MOORE, OK 73170-1472
(405) 201-8496
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
081111886
OK
Other
Enumeration date
05/29/2012
Last updated
05/29/2012
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