Individual provider Active NPI

Kelli Lee King, LPC, LADC

  • Mental Health Counselor
  • Broken Arrow, OK
National Provider Identifier
1497978555
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
3406 Issued in OK
Practice address
2017 S Elm PL Ste 104
Broken Arrow, OK 74012-7034
Phone
(918) 379-4431
Fax
(918) 328-2380
NPI assigned
Apr 10, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 3406 OK Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 205 OK

Addresses

Primary practice location

2017 S Elm PL Ste 104
Broken Arrow, OK 74012-7034

Mailing address

6931 S 66TH East Ave Ste 200
Tulsa, OK 74133-1765
Phone (918) 379-4431

Other practice location 1

6931 S 66th East Ave Ste 200
Tulsa, OK 74133-1765
Phone (918) 379-4431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241230000769 OK Practitioner - Mental Health Counselor 3375070527 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Evolution Mental Health Services PLLCGroup PAC ID 5496106593, 6 clinicians

Practice addresses (Care Compare)

6931 S 66TH E Ave
Suite 200
Tulsa, OK 74133-1765
Phone (918) 379-4431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3406OKMDChiropractor
205OKMDAudiologist-Hearing Aid Fitter

Practice roles

OrganizationSpecialtyStatusNew patients
Evolution Mental Health Services PLLC Mental Health CurrentSince Jan 2, 2025 Accepting new patients
Jeffrey K McIlroy MD Inc Past Accepting new patients
River Parks Developmental Center Past Accepting new patients
Behavioral Health Inc. Past Accepting new patients

Locations

2017 S Elm Pl
Ste 104
Broken Arrow, OK 74012
Phone (918) 379-4431

6931 S 66th East Ave
Ste 200
Tulsa, OK 74133
Phone (918) 379-4431

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768176000000",
    "number": "1497978555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6931 S 66TH EAST AVE STE 200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741331765",
            "telephone_number": "918-379-4431",
            "fax_number": "918-328-2380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 S ELM PL STE 104",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127034",
            "telephone_number": "918-379-4431",
            "fax_number": "918-328-2380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6931 S 66th East Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741331765",
            "country_code": "US",
            "telephone_number": "918-379-4431",
            "fax_number": "918-328-2380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "KELLI",
        "middle_name": "LEE",
        "credential": "LPC, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "3406",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.