Provider Demographics
NPI:1902098643
Name:KEELEY, SUSAN E (LMSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:KEELEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 W MILL AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2489
Mailing Address - Country:US
Mailing Address - Phone:208-755-7370
Mailing Address - Fax:208-292-4544
Practice Address - Street 1:1042 W MILL AVE STE 205
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2489
Practice Address - Country:US
Practice Address - Phone:208-755-7370
Practice Address - Fax:208-292-4544
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-27599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health