Provider Demographics
NPI:1871823336
Name:HOBBS, KELLY DAWN (BHCM II)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DAWN
Last Name:HOBBS
Suffix:
Gender:F
Credentials:BHCM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:CALUMET
Mailing Address - State:OK
Mailing Address - Zip Code:73014-0022
Mailing Address - Country:US
Mailing Address - Phone:405-837-0150
Mailing Address - Fax:
Practice Address - Street 1:1390 S DOUGLAS BLVD
Practice Address - Street 2:102
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5270
Practice Address - Country:US
Practice Address - Phone:405-455-5312
Practice Address - Fax:405-455-5279
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200120060AMedicaid