Provider Demographics
NPI:1912201658
Name:KEEFE, KRISTY MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:MARIE
Last Name:KEEFE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 YELLOW BIRD LN
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:KY
Mailing Address - Zip Code:40734-6656
Mailing Address - Country:US
Mailing Address - Phone:317-750-9794
Mailing Address - Fax:
Practice Address - Street 1:52 YELLOW BIRD LN
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:KY
Practice Address - Zip Code:40734-6656
Practice Address - Country:US
Practice Address - Phone:317-750-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical