Provider Demographics
NPI:1750451753
Name:OKEEFE & ASSOCIATES
Entity Type:Organization
Organization Name:OKEEFE & ASSOCIATES
Other - Org Name:ACEVEDO OKEEFE & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:OKEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-205-7613
Mailing Address - Street 1:5845 NO ST JOHNS CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6048
Mailing Address - Country:US
Mailing Address - Phone:773-205-7613
Mailing Address - Fax:773-205-7613
Practice Address - Street 1:5845 NO ST JOHNS CT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6048
Practice Address - Country:US
Practice Address - Phone:773-205-7613
Practice Address - Fax:773-205-7613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2549-057103T00000X
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL576200OtherBC BS
576200Medicare ID - Type Unspecified
IL576200OtherBC BS