Healthcare Provider Details

I. General information

NPI: 1043461031
Provider Name (Legal Business Name): KEVIN OKEEFE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 SANTA CLARA DR
SANTA CLARA UT
84765-5466
US

IV. Provider business mailing address

545 COUNTRY LN
SANTA CLARA UT
84765-5490
US

V. Phone/Fax

Practice location:
  • Phone: 801-319-6799
  • Fax: 801-406-0241
Mailing address:
  • Phone: 801-319-6799
  • Fax: 801-406-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number57695092504
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: