Provider Demographics
NPI:1568768315
Name:SUSAN KEELEY COUNSELING SERVICES, PC
Entity Type:Organization
Organization Name:SUSAN KEELEY COUNSELING SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-755-7370
Mailing Address - Street 1:1042 W MILL AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2489
Mailing Address - Country:US
Mailing Address - Phone:208-755-7370
Mailing Address - Fax:208-292-4544
Practice Address - Street 1:1042 W MILL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2489
Practice Address - Country:US
Practice Address - Phone:208-755-7370
Practice Address - Fax:208-292-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW30184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty