Provider Demographics
NPI:1063552123
Name:O'KEEFE-HARDY, LEE MARILYN (MFCC, PSYCH TECH LIS)
Entity type:Individual
Prefix:MS
First Name:LEE
Middle Name:MARILYN
Last Name:O'KEEFE-HARDY
Suffix:
Gender:F
Credentials:MFCC, PSYCH TECH LIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 SEABREEZE DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-2946
Mailing Address - Country:US
Mailing Address - Phone:310-456-1554
Mailing Address - Fax:
Practice Address - Street 1:2851 SEABREEZE DR
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2946
Practice Address - Country:US
Practice Address - Phone:310-456-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM16513101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional