Provider Demographics
NPI:1497097067
Name:BEAL, KEISHA D
Entity Type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:D
Last Name:BEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 W PHOENIX PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1818
Mailing Address - Country:US
Mailing Address - Phone:504-957-3384
Mailing Address - Fax:
Practice Address - Street 1:1306 W PHOENIX PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1818
Practice Address - Country:US
Practice Address - Phone:504-957-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor