Provider Demographics
NPI:1639363641
Name:MCKEEVER, BRADLEY EARLE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:EARLE
Last Name:MCKEEVER
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 1:4301 MOW WAY ROAD
Mailing Address - Street 2:
Mailing Address - City:FT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-6300
Mailing Address - Country:US
Mailing Address - Phone:580-458-2500
Mailing Address - Fax:
Practice Address - Street 1:4301 THOMAS STREET
Practice Address - Street 2:
Practice Address - City:FT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-6300
Practice Address - Country:US
Practice Address - Phone:580-458-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK09521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical