Provider Demographics
NPI:1598415093
Name:COOK, KELLI (LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 WILLOW CRK
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9467
Mailing Address - Country:US
Mailing Address - Phone:405-326-0234
Mailing Address - Fax:
Practice Address - Street 1:3917 E MEMORIAL RD STE A
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7230
Practice Address - Country:US
Practice Address - Phone:405-233-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional