MEDICARE: DR. THERESA LYNN KEOWN P.H.D., LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2006027493	MO

General Provider Information

NPI Number	:	1174893184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA LYNN KEOWN P.H.D., LPC, NCC

Provider Business Mailing Address
First Line	:	5858 S ROANOKE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-3223
Country	:	US
Telephone Number	:	573-915-7455
Fax Number	:

Provider Business Practice Location Address
First Line	:	5858 S ROANOKE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-3223
Country	:	US
Telephone Number	:	573-915-7455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	07/02/2025

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