Provider Demographics
NPI:1043943103
Name:KELLY VEELEY HEART THERAPY PLLC
Entity type:Organization
Organization Name:KELLY VEELEY HEART THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:VEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:405-777-8033
Mailing Address - Street 1:1404 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-5051
Mailing Address - Country:US
Mailing Address - Phone:405-777-8033
Mailing Address - Fax:
Practice Address - Street 1:1404 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-5051
Practice Address - Country:US
Practice Address - Phone:405-777-8033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty