Provider Demographics
NPI:1134270432
Name:RILEY, KEELYN TONYA (LCSW)
Entity type:Individual
Prefix:
First Name:KEELYN
Middle Name:TONYA
Last Name:RILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 TOHO TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-9502
Mailing Address - Country:US
Mailing Address - Phone:928-699-8027
Mailing Address - Fax:
Practice Address - Street 1:4 N SAN FRANCISCO ST
Practice Address - Street 2:SUITE D
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5230
Practice Address - Country:US
Practice Address - Phone:928-699-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSW-272911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical