Provider Demographics
NPI:1124918552
Name:HURST, KELLI (LPC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 PASEO BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-1094
Mailing Address - Country:US
Mailing Address - Phone:405-209-0494
Mailing Address - Fax:
Practice Address - Street 1:301 LILAC DR STE 230
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7432
Practice Address - Country:US
Practice Address - Phone:405-209-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health