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NPI Code Detail

MEDICARE: MR. NICK KEETER LAC

MEDICARE: MR. NICK KEETER LAC
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
1101YP2500XProfessional CounselorA0606033AR

General Provider Information

NPI Number : 1265477111
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NICK KEETER LAC
Provider Business Mailing Address
First Line : 10301 MAYO DR
Second Line :
City : BARLING
State : AR
Zip : 72923-1660
Country : US
Telephone Number : 479-494-5700
Fax Number : 479-494-5777
Provider Business Practice Location Address
First Line : 10301 MAYO DR
Second Line :
City : BARLING
State : AR
Zip : 72923-1660
Country : US
Telephone Number : 479-494-5700
Fax Number : 479-494-5777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2006
Last Update Date : 06/06/2008

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Directions to “ MR. NICK KEETER LAC” Practice Location

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