Healthcare Provider Details

I. General information

NPI: 1275440273
Provider Name (Legal Business Name): NW SYSTEMS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CANTERBURY LN
COLBERT WA
99005-5111
US

IV. Provider business mailing address

625 CANTERBURY LN
COLBERT WA
99005-5111
US

V. Phone/Fax

Practice location:
  • Phone: 509-818-0832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. STACY MICHELLE KEOGH
Title or Position: OWNER, CLINICIAN
Credential: MA, PHD
Phone: 509-818-0832