Provider Demographics
NPI:1386181105
Name:MITCHELL, KEELEY D (M ED)
Entity Type:Individual
Prefix:
First Name:KEELEY
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-7053
Mailing Address - Country:US
Mailing Address - Phone:405-273-6794
Mailing Address - Fax:405-878-1037
Practice Address - Street 1:326 N UNION AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-7053
Practice Address - Country:US
Practice Address - Phone:405-273-6794
Practice Address - Fax:405-878-1037
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK193606103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool