Provider Demographics
NPI:1295294874
Name:KEEKS, MALLORY KATHLEEN (LPC, LMHC, ATR)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:KATHLEEN
Last Name:KEEKS
Suffix:
Gender:F
Credentials:LPC, LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 N MOPAC EXPY STE 301
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8323
Mailing Address - Country:US
Mailing Address - Phone:609-417-1113
Mailing Address - Fax:
Practice Address - Street 1:8400 N MOPAC EXPY STE 301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8323
Practice Address - Country:US
Practice Address - Phone:512-503-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61454456101YP2500X
18-535221700000X
TX81143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist