Provider Demographics
NPI:1598387060
Name:JONES, KALLIE D (LMSW)
Entity Type:Individual
Prefix:
First Name:KALLIE
Middle Name:D
Last Name:JONES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KALLIE
Other - Middle Name:D
Other - Last Name:BRAKHAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:SEILING
Mailing Address - State:OK
Mailing Address - Zip Code:73663-0177
Mailing Address - Country:US
Mailing Address - Phone:580-922-5656
Mailing Address - Fax:580-922-3261
Practice Address - Street 1:423 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3839
Practice Address - Country:US
Practice Address - Phone:580-922-5656
Practice Address - Fax:580-922-3261
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8225104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator