Provider Demographics
NPI:1346684206
Name:KEELS, GLENN A
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:A
Last Name:KEELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 EASLER HWY
Mailing Address - Street 2:
Mailing Address - City:GREELEYVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29056-9124
Mailing Address - Country:US
Mailing Address - Phone:843-413-4943
Mailing Address - Fax:843-413-4943
Practice Address - Street 1:1119 N IRBY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-2621
Practice Address - Country:US
Practice Address - Phone:843-413-4943
Practice Address - Fax:843-413-4943
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No251300000XAgenciesLocal Education Agency (LEA)