Provider Demographics
NPI:1689425209
Name:WELLS, KALYN (LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:KALYN
Middle Name:
Last Name:WELLS
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 1:900 S SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5761
Mailing Address - Country:US
Mailing Address - Phone:405-318-5290
Mailing Address - Fax:
Practice Address - Street 1:6051 N BROOKLINE AVE STE 112
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4286
Practice Address - Country:US
Practice Address - Phone:405-810-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health