Provider Demographics
NPI:1275647349
Name:MOUNCE, KELLY RANAE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:RANAE
Last Name:MOUNCE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11670 GUN SMOKE DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-6437
Mailing Address - Country:US
Mailing Address - Phone:918-231-2500
Mailing Address - Fax:
Practice Address - Street 1:550 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3820
Practice Address - Country:US
Practice Address - Phone:918-382-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4137101YP2500X, 101YM0800X
IL178.009763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-1042545OtherCOMMUNITY CARE OF OKLAHOMA GROUP
OK100732910-AOtherMEDICAID/SOONERCARE GROUP
OK73-1042545OtherGROUP MEDICARE
OK73-1042545OtherBLUE CROSS BLUE SHIELD GROUP
OK731042545001OtherTRICARE GROUP