Provider Demographics
NPI:1497978555
Name:KING, KELLI LEE (LPC, LADC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:LEE
Last Name:KING
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6931 S 66TH EAST AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1765
Mailing Address - Country:US
Mailing Address - Phone:918-379-4431
Mailing Address - Fax:918-328-2380
Practice Address - Street 1:6931 S 66TH EAST AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1765
Practice Address - Country:US
Practice Address - Phone:918-379-4431
Practice Address - Fax:918-328-2380
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205101YA0400X
OK3406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)