Provider Demographics
NPI:1720162134
Name:KEISTER, CATHIE R (LMHC, LMHP)
Entity Type:Individual
Prefix:
First Name:CATHIE
Middle Name:R
Last Name:KEISTER
Suffix:
Gender:F
Credentials:LMHC, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S 15TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3900
Mailing Address - Country:US
Mailing Address - Phone:712-328-3940
Mailing Address - Fax:712-325-6161
Practice Address - Street 1:25 S 15TH ST STE 3
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3900
Practice Address - Country:US
Practice Address - Phone:712-328-3940
Practice Address - Fax:712-325-6161
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health