Healthcare Provider Details

I. General information

NPI: 1083080220
Provider Name (Legal Business Name): SHELLEY MARIE KEEVEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY MARIE SLATER LPC

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1006
US

IV. Provider business mailing address

7400 DEVONSHIRE AVE
SAINT LOUIS MO
63119-2831
US

V. Phone/Fax

Practice location:
  • Phone: 314-802-8805
  • Fax:
Mailing address:
  • Phone: 314-566-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2007027920
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: