MEDICARE: KELLI LEE KING LPC, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	3406	OK
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	205	OK

General Provider Information

NPI Number	:	1497978555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI LEE KING LPC, LADC

Provider Business Mailing Address
First Line	:	6931 S 66TH EAST AVE STE 200
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-1765
Country	:	US
Telephone Number	:	918-379-4431
Fax Number	:	918-328-2380

Provider Business Practice Location Address
First Line	:	2017 S ELM PL STE 104
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7034
Country	:	US
Telephone Number	:	918-379-4431
Fax Number	:	918-328-2380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	01/12/2026

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