Provider Demographics
NPI:1750720140
Name:KEEN, SARAH NICOLE
Entity type:Individual
Prefix:MR
First Name:SARAH
Middle Name:NICOLE
Last Name:KEEN
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 1:36916 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WISTER
Mailing Address - State:OK
Mailing Address - Zip Code:74966-2898
Mailing Address - Country:US
Mailing Address - Phone:918-721-3812
Mailing Address - Fax:
Practice Address - Street 1:2706 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5402
Practice Address - Country:US
Practice Address - Phone:918-647-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor