Provider Demographics
NPI:1881006369
Name:KEOUGHAN, ALLISSA (BA)
Entity Type:Individual
Prefix:MRS
First Name:ALLISSA
Middle Name:
Last Name:KEOUGHAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 MICAH DR
Mailing Address - Street 2:DRAWER M
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-4720
Mailing Address - Country:US
Mailing Address - Phone:618-395-4306
Mailing Address - Fax:618-395-4507
Practice Address - Street 1:407 N BASIN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-9639
Practice Address - Country:US
Practice Address - Phone:618-842-2125
Practice Address - Fax:618-842-4154
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health