Provider Demographics
NPI:1871964106
Name:KELLER GATES, VALERIE NICOLE (LPC)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:NICOLE
Last Name:KELLER GATES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:NICOLE
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 13353
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73113-1353
Mailing Address - Country:US
Mailing Address - Phone:405-312-5661
Mailing Address - Fax:
Practice Address - Street 1:8541 HURST CT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-4402
Practice Address - Country:US
Practice Address - Phone:405-312-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200619800CMedicaid