Provider Demographics
NPI:1003285321
Name:GABRIELLE K KEENUM MA LPC PC
Entity Type:Organization
Organization Name:GABRIELLE K KEENUM MA LPC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KEENUM
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:806-790-1327
Mailing Address - Street 1:6309 INDIANA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5739
Mailing Address - Country:US
Mailing Address - Phone:806-790-1327
Mailing Address - Fax:806-863-3874
Practice Address - Street 1:6309 INDIANA AVE STE D
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5739
Practice Address - Country:US
Practice Address - Phone:806-790-1327
Practice Address - Fax:806-863-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16235101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty