Provider Demographics
NPI:1356560379
Name:KEELY, KELLY DAWN (BA, BHRS)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DAWN
Last Name:KEELY
Suffix:
Gender:F
Credentials:BA, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 E HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:OK
Mailing Address - Zip Code:73007-7908
Mailing Address - Country:US
Mailing Address - Phone:405-272-0660
Mailing Address - Fax:
Practice Address - Street 1:1140 N HUDSON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3918
Practice Address - Country:US
Practice Address - Phone:405-272-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK450-50-5-2101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100734620Medicaid