Provider Demographics
NPI:1114706991
Name:KEIGHLEY, CODEE JOSEPH
Entity Type:Individual
Prefix:
First Name:CODEE
Middle Name:JOSEPH
Last Name:KEIGHLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 NW 3RD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5722
Mailing Address - Country:US
Mailing Address - Phone:772-626-7792
Mailing Address - Fax:
Practice Address - Street 1:622 NW 3RD AVE APT 4
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5722
Practice Address - Country:US
Practice Address - Phone:772-626-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty