| Doctor Name: | KELLI MABRY |
| NPI Number: | 1932481330 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BHRS |
| License Number: | |
| Business Practice Address: | 301 E Main Suite 3 Wilburton, OK - 745012314 |
| Business Phone Number: | 9184650300 |
| Business Fax Number: | 9184650300 |
| Mailing Address: | 6251 Sw 1070th Ave, WILBURTON |
| State: | OK |
| Postal Code: | 745787714 |
| Phone Number: | 9182304310 |
| Fax Number: | |
| NPI Enumeration Date: | 09/13/2011 |
| NPI Last Update Date: | 04/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |