Provider Demographics
NPI:1073721155
Name:MCKELVY, ROBERT WILLIAM (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:MCKELVY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 N PORTLAND AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6171
Mailing Address - Country:US
Mailing Address - Phone:405-603-3093
Mailing Address - Fax:405-601-5682
Practice Address - Street 1:4911 N PORTLAND AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6171
Practice Address - Country:US
Practice Address - Phone:405-603-3093
Practice Address - Fax:405-601-5682
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health