Healthcare Provider Details

I. General information

NPI: 1548967508
Provider Name (Legal Business Name): HALEY M KEEL CMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 MAIN ST
TOLEDO OH
43605-2397
US

IV. Provider business mailing address

1300 HIGHLAND CT
FREMONT OH
43420-4613
US

V. Phone/Fax

Practice location:
  • Phone: 281-888-8704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: