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NPI Code Detail

MEDICARE: MS. SHELLY ANN KERR LPC-CANDIDATE

MEDICARE: MS. SHELLY ANN KERR LPC-CANDIDATE
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
1171M00000XCase Manager/Care CoordinatorOK
2101Y00000XCounselorLPCCANDIDATE12619OK

General Provider Information

NPI Number : 1548906316
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHELLY ANN KERR LPC-CANDIDATE
Provider Business Mailing Address
First Line : 7204 S 73RD EAST AVE
Second Line :
City : TULSA
State : OK
Zip : 74133-2805
Country : US
Telephone Number : 918-691-8877
Fax Number :
Provider Business Practice Location Address
First Line : 300 N DENVER AVE
Second Line :
City : TULSA
State : OK
Zip : 74103-1420
Country : US
Telephone Number : 918-691-8877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2022
Last Update Date : 02/21/2025

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