Doctor Name: | BONNIE KEELEY |
NPI Number: | 1033140645 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC |
License Number: | 3457 |
Business Practice Address: | 314 S. Broadway Suite 106 Ada, OK - 74820 |
Business Phone Number: | 5802350210 |
Business Fax Number: | 5802350211 |
Mailing Address: | Po Box 662, PURCELL |
State: | OK |
Postal Code: | 730800662 |
Phone Number: | 4055271785 |
Fax Number: | 4055271084 |
NPI Enumeration Date: | 07/05/2006 |
NPI Last Update Date: | 03/22/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3457 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |