Healthcare Provider Details

I. General information

NPI: 1124918552
Provider Name (Legal Business Name): KELLI HURST LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LILAC DR STE 230
EDMOND OK
73034-7432
US

IV. Provider business mailing address

1408 PASEO BRIDGE CT
EDMOND OK
73034-1094
US

V. Phone/Fax

Practice location:
  • Phone: 405-209-0494
  • Fax:
Mailing address:
  • Phone: 405-209-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10058
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: