Provider Demographics
NPI:1568158103
Name:KEELE, GABIRIANNA
Entity Type:Individual
Prefix:
First Name:GABIRIANNA
Middle Name:
Last Name:KEELE
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 1:3900 SWISS AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6419
Mailing Address - Country:US
Mailing Address - Phone:931-980-7219
Mailing Address - Fax:
Practice Address - Street 1:602 STRADA CIR STE 115
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3201
Practice Address - Country:US
Practice Address - Phone:682-215-2061
Practice Address - Fax:817-887-3683
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical