Provider Demographics
NPI:1972634038
Name:O'KELLEY, SCOTT (LPC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:O'KELLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 OSCAR DR STE A
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-5197
Mailing Address - Country:US
Mailing Address - Phone:573-635-8299
Mailing Address - Fax:573-635-4629
Practice Address - Street 1:211 OSCAR DR STE A
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5197
Practice Address - Country:US
Practice Address - Phone:573-635-8299
Practice Address - Fax:573-635-4629
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005039815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health