Provider Demographics
NPI:1265849996
Name:NICK KEETER
Entity Type:Organization
Organization Name:NICK KEETER
Other - Org Name:KEETER COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEETER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:479-461-8738
Mailing Address - Street 1:10227 OLD 88 RD
Mailing Address - Street 2:
Mailing Address - City:RUDY
Mailing Address - State:AR
Mailing Address - Zip Code:72952-8525
Mailing Address - Country:US
Mailing Address - Phone:479-474-3744
Mailing Address - Fax:
Practice Address - Street 1:10227 OLD 88 RD
Practice Address - Street 2:
Practice Address - City:RUDY
Practice Address - State:AR
Practice Address - Zip Code:72952-8525
Practice Address - Country:US
Practice Address - Phone:479-474-3744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0908050101Y00000X, 101YP2500X
ARM0908005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty