Healthcare Provider Details

I. General information

NPI: 1154047314
Provider Name (Legal Business Name): KEELY JOHNSON PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 S KELLY AVE STE B
EDMOND OK
73013-2976
US

IV. Provider business mailing address

2529 S KELLY AVE STE B
EDMOND OK
73013-2976
US

V. Phone/Fax

Practice location:
  • Phone: 405-454-8016
  • Fax: 405-583-4963
Mailing address:
  • Phone: 405-454-8016
  • Fax: 405-583-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1418
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: