MEDICARE: KELCY ECKELS M.A., LPC

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	104100000X	Social Worker
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891077103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELCY ECKELS M.A., LPC

Provider Business Mailing Address
First Line	:	5225 N SHARTEL AVE
Second Line	:	SUITE 201
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6064
Country	:	US
Telephone Number	:	405-808-3987
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 N SHARTEL AVE
Second Line	:	SUITE 201
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6064
Country	:	US
Telephone Number	:	405-808-3987
Fax Number	:

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

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	11/20/2017

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