Provider Demographics
NPI:1174217608
Name:BRALLIER, KELLI SUE (LMSW)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:SUE
Last Name:BRALLIER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:SUE
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1313 W ASH AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4358
Mailing Address - Country:US
Mailing Address - Phone:580-475-0519
Mailing Address - Fax:
Practice Address - Street 1:1313 W ASH AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4358
Practice Address - Country:US
Practice Address - Phone:580-475-0519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20233-P104100000X
OK9204104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker