Provider Demographics
NPI:1285099200
Name:KEEL, SHAUN HAMLETT (EDD)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:HAMLETT
Last Name:KEEL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 52ND ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-2500
Mailing Address - Country:US
Mailing Address - Phone:806-792-3181
Mailing Address - Fax:806-792-3182
Practice Address - Street 1:2402 52ND ST
Practice Address - Street 2:SUITE 7
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2500
Practice Address - Country:US
Practice Address - Phone:806-792-3181
Practice Address - Fax:806-792-3182
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23761103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033541601Medicaid