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General NPI Number Information
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NPI Number | 1104254846
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Entity Type | Individual
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Provider Name | KELLY JAMETTE HOLLIDAY MS, LPCCANDIDATE
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Gender | Female
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 5310 E 31ST ST
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City | TULSA
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State | OK
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Zip | 74135-5012
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Country | US
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Telephone | 918-587-9471
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Fax |
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Provider Business Mailing Address
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Address Line | 5310 E 31ST ST
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City | TULSA
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State | OK
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Zip | 74135-5012
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Country | US
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Telephone | 918-587-9471
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPCCANDIDATE2305
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License Number State | OK
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