Provider Demographics
NPI:1437213956
Name:KELLETT, FELICIA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:ANN
Last Name:KELLETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-1810
Mailing Address - Country:US
Mailing Address - Phone:405-528-7724
Mailing Address - Fax:405-843-4453
Practice Address - Street 1:616 NW 21ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1810
Practice Address - Country:US
Practice Address - Phone:405-528-7724
Practice Address - Fax:405-843-4453
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3100OtherLCSW LICENSURE