Healthcare Provider Details

I. General information

NPI: 1386801942
Provider Name (Legal Business Name): LEVI TAYLOR KEEHLER M.S., LPC, LADC, CPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 MAHANEY AVE STE 4
TAHLEQUAH OK
74464-5795
US

IV. Provider business mailing address

2021 MAHANEY AVE STE 4
TAHLEQUAH OK
74464-5795
US

V. Phone/Fax

Practice location:
  • Phone: 918-901-9300
  • Fax: 918-901-9339
Mailing address:
  • Phone: 918-901-9300
  • Fax: 918-901-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number606
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3992
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3992
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: