Provider Demographics
NPI:1205076932
Name:MCGEE, KEITH GLENN (MED, LPC, EMDR)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:GLENN
Last Name:MCGEE
Suffix:
Gender:M
Credentials:MED, LPC, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:TX
Mailing Address - Zip Code:75568-0444
Mailing Address - Country:US
Mailing Address - Phone:903-853-5053
Mailing Address - Fax:866-414-6442
Practice Address - Street 1:200 W MARSHALL ST STE 1
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-1348
Practice Address - Country:US
Practice Address - Phone:903-853-5053
Practice Address - Fax:866-414-6442
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59169101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1205076932Medicaid