Healthcare Provider Details

I. General information

NPI: 1013559509
Provider Name (Legal Business Name): KEELEY CASTEEL MSW, LMSW, MAADC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 01/12/2020
Certification Date: 01/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E BENNETT ST STE B
SPRINGFIELD MO
65804-1427
US

IV. Provider business mailing address

1901 E BENNETT ST STE B
SPRINGFIELD MO
65804-1427
US

V. Phone/Fax

Practice location:
  • Phone: 417-409-3008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2018036547
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: