Provider Demographics
NPI:1659952893
Name:KEEFE, TIPHANIE (NCSP)
Entity Type:Individual
Prefix:MRS
First Name:TIPHANIE
Middle Name:
Last Name:KEEFE
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RURAL AVE
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2139
Mailing Address - Country:US
Mailing Address - Phone:406-672-8370
Mailing Address - Fax:
Practice Address - Street 1:101 RURAL AVE
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2139
Practice Address - Country:US
Practice Address - Phone:406-672-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1004270103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool