Healthcare Provider Details

I. General information

NPI: 1871823336
Provider Name (Legal Business Name): KELLY DAWN HOBBS BHCM II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 S DOUGLAS BLVD 102
MIDWEST CITY OK
73130-5270
US

IV. Provider business mailing address

PO BOX 22
CALUMET OK
73014-0022
US

V. Phone/Fax

Practice location:
  • Phone: 405-455-5312
  • Fax: 405-455-5279
Mailing address:
  • Phone: 405-837-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: