Provider Demographics
NPI:1356476691
Name:KELTNER, JUDY ANN (MHR LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ANN
Last Name:KELTNER
Suffix:
Gender:F
Credentials:MHR LPC
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:KELTNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHR LPC
Mailing Address - Street 1:650 S PEORIA
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-560-0137
Practice Address - Street 1:2325 S HARVARD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3300
Practice Address - Country:US
Practice Address - Phone:918-712-4301
Practice Address - Fax:918-712-3409
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional