Provider Demographics
NPI:1417056946
Name:CARLEY, KEENAN GREG (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEENAN
Middle Name:GREG
Last Name:CARLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 94TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-4412
Mailing Address - Country:US
Mailing Address - Phone:806-789-1379
Mailing Address - Fax:
Practice Address - Street 1:6502 SLIDE RD
Practice Address - Street 2:207
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1329
Practice Address - Country:US
Practice Address - Phone:806-771-8808
Practice Address - Fax:806-771-8809
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical