Provider Demographics
NPI:1093986168
Name:KEOLAVONE, MISTY (LSCSW)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:KEOLAVONE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 HIGH PLAINS CIR
Mailing Address - Street 2:
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-9309
Mailing Address - Country:US
Mailing Address - Phone:316-655-3881
Mailing Address - Fax:
Practice Address - Street 1:500 REFORMATORY ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-3081
Practice Address - Country:US
Practice Address - Phone:620-662-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4421104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker