Doctor Name: | KEELEY SMITH |
NPI Number: | 1366890170 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 2815 |
Business Practice Address: | 1501 E Peoria St Paola, KS - 660712117 |
Business Phone Number: | 9135574000 |
Business Fax Number: | |
Mailing Address: | 12225 S Blackbob Rd, Apt 306 OLATHE |
State: | KS |
Postal Code: | 660626836 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/02/2016 |
NPI Last Update Date: | 06/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2815 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |