Healthcare Provider Details

I. General information

NPI: 1437213956
Provider Name (Legal Business Name): FELICIA ANN KELLETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 NW 21ST ST
OKLAHOMA CITY OK
73103-1810
US

IV. Provider business mailing address

616 NW 21ST ST
OKLAHOMA CITY OK
73103-1810
US

V. Phone/Fax

Practice location:
  • Phone: 405-528-7724
  • Fax: 405-843-4453
Mailing address:
  • Phone: 405-528-7724
  • Fax: 405-843-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3100
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: