Healthcare Provider Details

I. General information

NPI: 1063978559
Provider Name (Legal Business Name): JOHN C KEEL MED, LMHC, LPC, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12715 E MISSION AVE
SPOKANE VALLEY WA
99216-1027
US

IV. Provider business mailing address

12715 E MISSION AVE
SPOKANE VALLEY WA
99216-1027
US

V. Phone/Fax

Practice location:
  • Phone: 509-232-5766
  • Fax:
Mailing address:
  • Phone: 509-232-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2019022129
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61088852
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2017031420
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: