Provider Demographics
NPI:1649591496
Name:KEELEY, MARY L (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:KEELEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2055 MOUNT PARAN RD NW
Mailing Address - Street 2:MCCARTY BUILDING
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2921
Mailing Address - Country:US
Mailing Address - Phone:404-835-6135
Mailing Address - Fax:404-239-9460
Practice Address - Street 1:2055 MOUNT PARAN RD NW
Practice Address - Street 2:MCCARTY BUILDING
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2921
Practice Address - Country:US
Practice Address - Phone:404-835-6135
Practice Address - Fax:404-239-9460
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003367103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent