Provider Demographics
NPI:1528348414
Name:CROWFOOT, KEELEY
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:
Last Name:CROWFOOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 BRODIE LN STE 205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6284
Mailing Address - Country:US
Mailing Address - Phone:512-420-8444
Mailing Address - Fax:
Practice Address - Street 1:12000 DESSAU RD APT 511
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-2088
Practice Address - Country:US
Practice Address - Phone:970-690-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37398103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist