| Doctor Name: | JACK KEGLEY |
| NPI Number: | 1639573165 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PC |
| License Number: | C-6351 |
| Business Practice Address: | 950 Meadow Dr Ste A Mount Gilead, OH - 433381389 |
| Business Phone Number: | 4199474560 |
| Business Fax Number: | 4199472956 |
| Mailing Address: | 950 Meadow Dr Ste A, MOUNT GILEAD |
| State: | OH |
| Postal Code: | 433381389 |
| Phone Number: | 4199474560 |
| Fax Number: | 4199472956 |
| NPI Enumeration Date: | 10/13/2014 |
| NPI Last Update Date: | 10/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | C-6351 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |