MEDICARE: JENNIFER KELLY COUNSELING SERVICES PLLC

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	101YP2500X	Professional Counselor	4273	OK

General Provider Information

NPI Number	:	1710254420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER KELLY COUNSELING SERVICES PLLC

Provider Business Mailing Address
First Line	:	530 POINTE PARKWAY BLVD STE B
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-0600
Country	:	US
Telephone Number	:	405-640-1973
Fax Number	:	405-708-5349

Provider Business Practice Location Address
First Line	:	530 POINTE PARKWAY BLVD STE B
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-0600
Country	:	US
Telephone Number	:	405-640-1973
Fax Number	:	405-708-5349

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	JENNIFER ANN KELLY
Credential	:	MS LPC
Telephone Number	:	405-640-1973

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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