Provider Demographics
NPI:1609487677
Name:MCKEEHAN, ELIZABETH COOK
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:COOK
Last Name:MCKEEHAN
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 1:949 SPRING OAK CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6990
Mailing Address - Country:US
Mailing Address - Phone:336-899-3329
Mailing Address - Fax:
Practice Address - Street 1:1850 LEE RD STE 250
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2116
Practice Address - Country:US
Practice Address - Phone:407-647-7005
Practice Address - Fax:407-647-8874
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor