Provider Demographics
NPI:1952455545
Name:CRAIG, KELLY (MBS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MBS, LPC
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 462
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-0462
Mailing Address - Country:US
Mailing Address - Phone:580-317-6081
Mailing Address - Fax:
Practice Address - Street 1:6216 S LEWIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1075
Practice Address - Country:US
Practice Address - Phone:918-960-7852
Practice Address - Fax:580-298-6699
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health