Provider Demographics
NPI:1114559093
Name:O'KEEFE, NICHOLE DIANNE (LPC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:DIANNE
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2018
Mailing Address - Country:US
Mailing Address - Phone:810-373-5133
Mailing Address - Fax:810-202-7899
Practice Address - Street 1:117 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2018
Practice Address - Country:US
Practice Address - Phone:810-373-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017410101YP2500X
MI6401019477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional