Provider Demographics
NPI:1467070565
Name:HINES, KELSEY (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:HINES
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 1:1117 WOODFORD CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6448
Mailing Address - Country:US
Mailing Address - Phone:580-890-9653
Mailing Address - Fax:
Practice Address - Street 1:2000 E 15TH ST STE 450C
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6670
Practice Address - Country:US
Practice Address - Phone:580-890-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health