Healthcare Provider Details

I. General information

NPI: 1124191895
Provider Name (Legal Business Name): LAURA MCKEE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 NORTH FIRST EAST STREET
DRIGGS ID
83422
US

IV. Provider business mailing address

PO BOX 983
DRIGGS ID
83422-0983
US

V. Phone/Fax

Practice location:
  • Phone: 208-201-5230
  • Fax: 208-787-5230
Mailing address:
  • Phone: 208-201-5230
  • Fax: 208-787-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY-202283
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number344
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: