Healthcare Provider Details

I. General information

NPI: 1013243419
Provider Name (Legal Business Name): GREY MCKELLAR MSW,LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 E 66TH PL
TULSA OK
74136-3701
US

IV. Provider business mailing address

6262 S SHERIDAN RD
TULSA OK
74133-4055
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-8200
  • Fax: 918-488-0940
Mailing address:
  • Phone: 918-492-8200
  • Fax: 918-493-3268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberH2889
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: