Provider Demographics
NPI:1326546029
Name:KEELER, MEGHAN (MED LPC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:KEELER
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 FORUM BLVD STE 4A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5468
Mailing Address - Country:US
Mailing Address - Phone:573-427-2602
Mailing Address - Fax:
Practice Address - Street 1:2800 FORUM BLVD STE 4A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5468
Practice Address - Country:US
Practice Address - Phone:573-427-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015034341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional