Provider Demographics
NPI:1740755271
Name:GRAY, KELSEY RAE (LMFT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:RAE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:RAE
Other - Last Name:LINSENMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2007 N MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3024
Mailing Address - Country:US
Mailing Address - Phone:405-226-0644
Mailing Address - Fax:
Practice Address - Street 1:1601 N KICKAPOO AVE STE 900
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4313
Practice Address - Country:US
Practice Address - Phone:405-585-6413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10052106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist