Healthcare Provider Details

I. General information

NPI: 1528105624
Provider Name (Legal Business Name): LAURA MCKEE PSY D L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 NORTH 1ST EAST STREET
DRIGGS ID
83422
US

IV. Provider business mailing address

P.O. BOX 983
DRIGGS ID
83422-0983
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number344
License Number StateWY

VIII. Authorized Official

Name: DR. LAURA MCKEE
Title or Position: DOCTOR OF PSYCHOLOGY
Credential: PSY.D.
Phone: 208-201-5230