Healthcare Provider Details

I. General information

NPI: 1629470059
Provider Name (Legal Business Name): EMILY KEEFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 BEE CAVE RD BLDG. 2, SUITE 200
AUSTIN TX
78746-5004
US

IV. Provider business mailing address

7004 BEE CAVE RD BLDG. 2, SUITE 200
AUSTIN TX
78746-5004
US

V. Phone/Fax

Practice location:
  • Phone: 512-306-1394
  • Fax:
Mailing address:
  • Phone: 512-306-1394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number56603
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: