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General NPI Number Information
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NPI Number | 1295294874
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Entity Type | Individual
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Provider Name | MALLORY KATHLEEN KEEKS LPC, LMHC, ATR
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Gender | Female
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 8400 N MOPAC EXPY STE 301
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City | AUSTIN
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State | TX
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Zip | 78759-8323
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Country | US
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Telephone | 512-503-5030
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Fax |
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Provider Business Mailing Address
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Address Line | 8400 N MOPAC EXPY STE 301
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City | AUSTIN
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State | TX
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Zip | 78759-8323
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Country | US
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Telephone | 609-417-1113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LH61454456
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 18-535
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 81143
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License Number State | TX
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