| Shelly Marie Kennedy-gonzalez, LPC | |
|
2017 S Elm Pl Ste 104, Broken Arrow, OK 74012-7034 | |
| (918) 379-4431 | |
| (918) 328-2380 |
| Full Name | Shelly Marie Kennedy-gonzalez |
|---|---|
| Gender | Female |
| Speciality | Mental Health Counselor |
| Experience | 10 Years |
| Location | 2017 S Elm Pl Ste 104, Broken Arrow, Oklahoma |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679923320 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 06888 (Oklahoma) | Primary |
| 101Y00000X | Counselor | 6888 (Oklahoma) | Secondary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Evolution Mental Health Services Pllc | 5496106593 | 6 |
| Entity Name | Evolution Mental Health Services Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1831714815 PECOS PAC ID: 5496106593 Enrollment ID: O20240112000878 |
| Mailing Address | Practice Location Address |
|---|---|
| Shelly Marie Kennedy-gonzalez, LPC 6931 S 66th East Ave Ste 200, Tulsa, OK 74133-1765 Ph: (918) 379-4431 | Shelly Marie Kennedy-gonzalez, LPC 2017 S Elm Pl Ste 104, Broken Arrow, OK 74012-7034 Ph: (918) 379-4431 |
Ashtyn Carley Freeny, Counselor Medicare: Not Enrolled in Medicare Practice Location: 3300 S Aspen Ave Ste D, Broken Arrow, OK 74012 Phone: 918-940-7158 Fax: 918-512-2002 | |
Miss Ashley R Wale, MHR ,LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 3112 S Nyssa Ave, Broken Arrow, OK 74012 Phone: 918-813-6684 | |
Ms. Edwyna Warrior Walker, BSED MED Counselor Medicare: Not Enrolled in Medicare Practice Location: 2700 N 7th St, Apt. 1214, Broken Arrow, OK 74012 Phone: 918-869-8200 | |
Katherine Silvey Bates, MCMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 512 W Atlanta St, Broken Arrow, OK 74012 Phone: 918-615-6620 | |
Robin Lynn Mayo, BA, MS Counselor Medicare: Not Enrolled in Medicare Practice Location: 508 E Natchez St, Broken Arrow, OK 74011 Phone: 918-260-7605 | |
Jacie Michelle Cook, LPC-C Counselor Medicare: Not Enrolled in Medicare Practice Location: 102 N Elm Pl Ste G, Broken Arrow, OK 74012 Phone: 918-383-2426 | |
Fady Srour, M.A, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 19426 E 49th St S, Broken Arrow, OK 74014 Phone: 918-355-4253 |