Provider Demographics
NPI:1174623201
Name:BENDER, KELLY (LPC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-1306
Mailing Address - Country:US
Mailing Address - Phone:405-326-8945
Mailing Address - Fax:405-735-5265
Practice Address - Street 1:1922 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5605
Practice Address - Country:US
Practice Address - Phone:405-325-8945
Practice Address - Fax:405-735-5265
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health