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General NPI Number Information
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NPI Number | 1528476967
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Entity Type | Organization
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Legal Business Name | KILEY ELLEGARD, PLLC
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 14001 MCAULEY BLVD SUITE 240
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-7004
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Country | US
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Telephone | 405-229-9514
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Fax |
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Provider Business Mailing Address
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Address Line | 14001 MCAULEY BLVD SUITE 240
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-7004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | KILEY ELLEGARD
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Credential | MA, LPC
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Telephone | 405-229-9514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5259
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License Number State | OK
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