Healthcare Provider Details

I. General information

NPI: 1255871703
Provider Name (Legal Business Name): KELLEY BAILEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N BROADWAY STE 112
EDMOND OK
73034-3642
US

IV. Provider business mailing address

3325 FRENCH PARK DR SUITE 9
EDMOND OK
73034-7277
US

V. Phone/Fax

Practice location:
  • Phone: 405-474-1813
  • Fax:
Mailing address:
  • Phone: 405-474-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6232
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6232
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6232
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6232
License Number StateOK

VIII. Authorized Official

Name: KELLEY R BAILEY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential:
Phone: 405-474-1813