Provider Demographics
NPI:1497978555
Name:KING, KELLI LEE (MS LPC LADC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:LEE
Last Name:KING
Suffix:
Gender:F
Credentials:MS LPC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105
Mailing Address - Country:US
Mailing Address - Phone:918-747-1600
Mailing Address - Fax:918-749-2774
Practice Address - Street 1:5512 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105
Practice Address - Country:US
Practice Address - Phone:918-747-1600
Practice Address - Fax:918-749-2774
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205101YA0400X
OK3406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)