Provider Demographics
NPI:1326594235
Name:MCKEAN, CALEB D (MA)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:D
Last Name:MCKEAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5655
Mailing Address - Country:US
Mailing Address - Phone:575-302-0698
Mailing Address - Fax:
Practice Address - Street 1:11212 N MAY AVE
Practice Address - Street 2:STE 107
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6336
Practice Address - Country:US
Practice Address - Phone:575-302-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC-6150101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral