Provider Demographics
NPI:1083080220
Name:KEEVEN, SHELLEY MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:MARIE
Last Name:KEEVEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:SHELLEY
Other - Middle Name:MARIE
Other - Last Name:SLATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:7400 DEVONSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2831
Mailing Address - Country:US
Mailing Address - Phone:314-566-8864
Mailing Address - Fax:
Practice Address - Street 1:2811 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1006
Practice Address - Country:US
Practice Address - Phone:314-802-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007027920101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor