Provider Demographics
NPI:1134576952
Name:CAFFEY, KELI LANEE
Entity type:Individual
Prefix:
First Name:KELI
Middle Name:LANEE
Last Name:CAFFEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELI
Other - Middle Name:LANEE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BHCM
Mailing Address - Street 1:1617 E. PARK
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701
Mailing Address - Country:US
Mailing Address - Phone:580-603-0797
Mailing Address - Fax:
Practice Address - Street 1:317 W. CHEROKEE SUITE B
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701
Practice Address - Country:US
Practice Address - Phone:888-573-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-22
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health