Provider Demographics
NPI:1114707171
Name:KEETON, CHRISTINA (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KEETON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:VAN DRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PIERCE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65723-2100
Mailing Address - Country:US
Mailing Address - Phone:417-476-1013
Mailing Address - Fax:417-476-1082
Practice Address - Street 1:1701 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-9999
Practice Address - Country:US
Practice Address - Phone:417-476-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023038358104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker