Kelli Wilson, MBS
Individual provider Active NPI Professional Counselor · Calera, OK
NPI 1215069356 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215069356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 2732 (OK)
- Practice address
- 221 Ridgecrest Dr
Calera, OK 74730-2510 - Phone
- (580) 924-6363
- Fax
- (580) 924-0379
- NPI assigned
- Mar 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2732 | OK | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2732 | OK | Yes |
Addresses
Primary practice location
221 Ridgecrest Dr
Calera, OK 74730-2510
Mailing address
221 Ridgecrest Dr
Calera, OK 74730-2510
Phone (580) 924-6363
Other providers in Calera, OK
All providers in Calera, OK · Professional Counselor in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.