Provider Demographics
NPI:1346366788
Name:DUNN, KELLIE (BA, CADC)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:BA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 E 9TH ST
Mailing Address - Street 2:SUITE 423
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-6943
Mailing Address - Country:US
Mailing Address - Phone:405-878-0464
Mailing Address - Fax:405-878-0469
Practice Address - Street 1:23 E 9TH ST
Practice Address - Street 2:SUITE 423
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6943
Practice Address - Country:US
Practice Address - Phone:405-878-0464
Practice Address - Fax:405-878-0469
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)