Healthcare Provider Details

I. General information

NPI: 1376478990
Provider Name (Legal Business Name): KELLY HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N GREENWOOD AVE STE 131
TULSA OK
74120-1444
US

IV. Provider business mailing address

2924 E PORTLAND PL
BROKEN ARROW OK
74014-3491
US

V. Phone/Fax

Practice location:
  • Phone: 918-933-8362
  • Fax:
Mailing address:
  • Phone: 918-933-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: