Healthcare Provider Details

I. General information

NPI: 1588426308
Provider Name (Legal Business Name): KAELY LINDSAY LPC-CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PARK ST SE
ARDMORE OK
73401
US

IV. Provider business mailing address

1602 ROSEDALE ST
ARDMORE OK
73401-3718
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-1838
  • Fax:
Mailing address:
  • Phone: 580-504-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12489
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: