MEDICARE: KELLEY BAILEY

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		OK

General Provider Information

NPI Number	:	1952713877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY BAILEY

Provider Business Mailing Address
First Line	:	1800 CHAPARRAL LN
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-6636
Country	:	US
Telephone Number	:	405-474-1813
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 N BROADWAY STE 112
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-3642
Country	:	US
Telephone Number	:	405-601-5616
Fax Number	:

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

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	01/16/2025

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Directions to “ KELLEY BAILEY ” Practice Location

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