Provider Demographics
NPI:1972622637
Name:KEOGH, MARLIES (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:MARLIES
Middle Name:
Last Name:KEOGH
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 1:1213 HYLTON HEIGHTS RD
Mailing Address - Street 2:STE 125
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2810
Mailing Address - Country:US
Mailing Address - Phone:785-565-0678
Mailing Address - Fax:785-539-3268
Practice Address - Street 1:1213 HYLTON HEIGHTS RD
Practice Address - Street 2:STE 125
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2810
Practice Address - Country:US
Practice Address - Phone:785-565-0678
Practice Address - Fax:785-539-3268
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 1346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS066858OtherPROVIDER NUMBER