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General NPI Number Information
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NPI Number | 1265849996
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Entity Type | Organization
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Legal Business Name | NICK KEETER
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 10227 OLD 88 RD
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City | RUDY
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State | AR
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Zip | 72952-8525
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Country | US
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Telephone | 479-474-3744
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Fax |
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Provider Business Mailing Address
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Address Line | 10227 OLD 88 RD
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City | RUDY
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State | AR
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Zip | 72952-8525
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Country | US
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Telephone | 479-474-3744
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MR. NICK KEETER
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Credential | LPC, LMFT
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Telephone | 479-461-8738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | P0908050
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P0908050
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M0908005
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License Number State | AR
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