Provider Demographics
NPI:1770508038
Name:KEEBLER, CHERYL MARGARET (PHD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARGARET
Last Name:KEEBLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5810
Mailing Address - Country:US
Mailing Address - Phone:228-523-4350
Mailing Address - Fax:
Practice Address - Street 1:4151 COBBLESTONE LN
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5810
Practice Address - Country:US
Practice Address - Phone:228-523-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS32 478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical