Provider Demographics
NPI:1841047222
Name:KEELY-BUSBOOM, ZOEY ANN
Entity type:Individual
Prefix:
First Name:ZOEY
Middle Name:ANN
Last Name:KEELY-BUSBOOM
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 1:1980 STARGAZE WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2837
Mailing Address - Country:US
Mailing Address - Phone:775-771-7516
Mailing Address - Fax:
Practice Address - Street 1:431 W PLUMB LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3766
Practice Address - Country:US
Practice Address - Phone:702-319-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician