Healthcare Provider Details

I. General information

NPI: 1386181105
Provider Name (Legal Business Name): KEELEY D MITCHELL M. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 N UNION AVE
SHAWNEE OK
74801-7053
US

IV. Provider business mailing address

326 N UNION AVE
SHAWNEE OK
74801-7053
US

V. Phone/Fax

Practice location:
  • Phone: 405-273-6794
  • Fax: 405-878-1037
Mailing address:
  • Phone: 405-273-6794
  • Fax: 405-878-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number193606
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: