MEDICARE: KELLIE SPERRY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		OK

General Provider Information

NPI Number	:	1427293026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE SPERRY LPC

Provider Business Mailing Address
First Line	:	13301 N MERIDIAN AVE STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8357
Country	:	US
Telephone Number	:	405-752-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	13301 N MERIDIAN AVE STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8357
Country	:	US
Telephone Number	:	405-752-9500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2008
Last Update Date	:	02/20/2023

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Directions to “ KELLIE SPERRY LPC” Practice Location

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