Provider Demographics
NPI:1164753976
Name:KEENAN, LESLIE SUSAN
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:SUSAN
Last Name:KEENAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 S MEMORIAL DR STE 111
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9006
Mailing Address - Country:US
Mailing Address - Phone:918-488-8002
Mailing Address - Fax:
Practice Address - Street 1:5840 S MEMORIAL DR STE 111
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9006
Practice Address - Country:US
Practice Address - Phone:918-488-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health