Provider Demographics
NPI:1639715261
Name:THURMAN, KEELY SHAE
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:SHAE
Last Name:THURMAN
Suffix:
Gender:F
Credentials:
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 1012
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-1012
Mailing Address - Country:US
Mailing Address - Phone:580-271-7080
Mailing Address - Fax:580-298-2081
Practice Address - Street 1:193908 US HIGHWAY 271
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-1386
Practice Address - Country:US
Practice Address - Phone:580-271-7080
Practice Address - Fax:580-298-2081
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor