MEDICARE: MS. MARY KATHLEEN O'KEEFFE MA, LMFT

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	106H00000X	Marriage & Family Therapist	LMT223	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356372007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY KATHLEEN O'KEEFFE MA, LMFT

Provider Business Mailing Address
First Line	:	1167 SPRATLIN PARK DR
Second Line	:
City	:	GRAY
State	:	TN
Zip	:	37615-6205
Country	:	US
Telephone Number	:	423-467-3600
Fax Number	:	423-467-3644

Provider Business Practice Location Address
First Line	:	1570 WAVERLY RD
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2523
Country	:	US
Telephone Number	:	423-224-1300
Fax Number	:	423-467-3644

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/01/2015

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