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General NPI Number Information
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NPI Number | 1548648496
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Entity Type | Individual
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Provider Name | STEPHANIE KEATHLEY LPC
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Gender | Female
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 14799 DIX TOLEDO RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-2507
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Country | US
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Telephone | 734-324-8326
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Fax | 734-324-8327
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Provider Business Mailing Address
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Address Line | 25170 SUPERIOR RD
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City | TAYLOR
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State | MI
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Zip | 48180-4517
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Country | US
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Telephone | 313-929-4747
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401014756
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License Number State | MI
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