Healthcare Provider Details

I. General information

NPI: 1235037565
Provider Name (Legal Business Name): KELSEY LYNNE SHOPE - ALLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2026
Last Update Date: 10/27/2026
Certification Date: 10/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E HILLSIDE DR
BROKEN ARROW OK
74014-6505
US

IV. Provider business mailing address

12933 S 124TH EAST AVE
BROKEN ARROW OK
74011-5608
US

V. Phone/Fax

Practice location:
  • Phone: 918-355-0993
  • Fax:
Mailing address:
  • Phone: 918-852-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9266
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: