Basic Information
Provider Information
NPI: 1669719878
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEEL
FirstName: HANNAH
MiddleName: MICHELLE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4400 N LINCOLN BLVD
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731055104
CountryCode: US
TelephoneNumber: 4054247711
FaxNumber:  
Practice Location
Address1: 4400 N LINCOLN BLVD
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731055104
CountryCode: US
TelephoneNumber: 4054247711
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/08/2013
LastUpdateDate: 09/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X  Y Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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