Provider Demographics
NPI:1992566053
Name:KEATHLEY, MARY ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:KEATHLEY
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:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:WORTHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76693-0254
Mailing Address - Country:US
Mailing Address - Phone:903-388-6231
Mailing Address - Fax:
Practice Address - Street 1:2977 LCR 244
Practice Address - Street 2:
Practice Address - City:WORTHAM
Practice Address - State:TX
Practice Address - Zip Code:76693
Practice Address - Country:US
Practice Address - Phone:903-484-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional