Healthcare Provider Details

I. General information

NPI: 1073900833
Provider Name (Legal Business Name): KELLI POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 W E AVE
ELK CITY OK
73644-2453
US

IV. Provider business mailing address

1510 W E AVE
ELK CITY OK
73644-2453
US

V. Phone/Fax

Practice location:
  • Phone: 580-243-9776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7627
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: