Provider Demographics
NPI:1124338512
Name:KEITH, CHRISTY (MASTER ED)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:MASTER ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1512
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-1512
Mailing Address - Country:US
Mailing Address - Phone:580-465-4171
Mailing Address - Fax:
Practice Address - Street 1:721 S GEORGE NIGH EXPY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7400
Practice Address - Country:US
Practice Address - Phone:580-465-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health