Provider Demographics
NPI:1891074209
Name:ROBERT W. MCKELVY, LPC PLLC
Entity Type:Organization
Organization Name:ROBERT W. MCKELVY, LPC PLLC
Other - Org Name:FAMILY THERAPY INSTITUTE NORTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCKELVY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-570-1066
Mailing Address - Street 1:5300 W MEMORIAL RD
Mailing Address - Street 2:4F
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2029
Mailing Address - Country:US
Mailing Address - Phone:405-570-1066
Mailing Address - Fax:
Practice Address - Street 1:5300 W MEMORIAL RD
Practice Address - Street 2:4F
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2029
Practice Address - Country:US
Practice Address - Phone:405-570-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3471101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty