Provider Demographics
NPI:1336682475
Name:SICARD, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SICARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 SE 59TH ST APT 129
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-5706
Mailing Address - Country:US
Mailing Address - Phone:405-501-5513
Mailing Address - Fax:
Practice Address - Street 1:728 SE 59TH ST APT 129
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-5706
Practice Address - Country:US
Practice Address - Phone:405-501-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor