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General NPI Number Information
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NPI Number | 1710254420
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Entity Type | Organization
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Legal Business Name | JENNIFER KELLY COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 530 POINTE PARKWAY BLVD STE B
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City | YUKON
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State | OK
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Zip | 73099-0600
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Country | US
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Telephone | 405-640-1973
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Fax | 405-708-5349
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Provider Business Mailing Address
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Address Line | 530 POINTE PARKWAY BLVD STE B
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City | YUKON
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State | OK
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Zip | 73099-0600
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Country | US
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Telephone | 405-640-1973
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Fax | 405-708-5349
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | JENNIFER ANN KELLY
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Credential | MS LPC
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Telephone | 405-640-1973
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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 | 4273
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License Number State | OK
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