Healthcare Provider Details

I. General information

NPI: 1568768315
Provider Name (Legal Business Name): SUSAN KEELEY COUNSELING SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8944 N HESS ST STE B
HAYDEN ID
83835-9183
US

IV. Provider business mailing address

PO BOX 367
HAYDEN ID
83835-0367
US

V. Phone/Fax

Practice location:
  • Phone: 208-755-7370
  • Fax: 208-545-8838
Mailing address:
  • Phone: 208-755-7370
  • Fax: 208-545-8838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW30184
License Number StateID

VIII. Authorized Official

Name: SUSAN E KEELEY
Title or Position: OWNER/COUNSELOR
Credential: LCSW
Phone: 208-755-7370