Healthcare Provider Details

I. General information

NPI: 1346684206
Provider Name (Legal Business Name): GLENN A. KEELS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 N IRBY ST
FLORENCE SC
29501-2621
US

IV. Provider business mailing address

1321 EASLER HWY
GREELEYVILLE SC
29056-9124
US

V. Phone/Fax

Practice location:
  • Phone: 843-413-4943
  • Fax: 843-413-4943
Mailing address:
  • Phone: 843-413-4943
  • Fax: 843-413-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: