Provider Demographics
NPI:1952481855
Name:KEESLER, THOMAS YATES (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:YATES
Last Name:KEESLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 HIGH MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27306-9308
Mailing Address - Country:US
Mailing Address - Phone:704-438-0294
Mailing Address - Fax:910-571-0234
Practice Address - Street 1:617 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2710
Practice Address - Country:US
Practice Address - Phone:910-572-2225
Practice Address - Fax:910-571-0234
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1495103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical