Mary Elizabeth Keathley
Individual provider Active NPI Professional Counselor · Wortham, TX
NPI 1992566053 · NPPES record last updated Jan 17, 2024
Key facts
- NPI
- 1992566053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 93796 (TX)
- Practice address
- 2977 LCR 244
Wortham, TX 76693 - Phone
- (903) 484-6501
- NPI assigned
- Jan 17, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 93796 | TX | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 93796 | TX | Yes |
Addresses
Primary practice location
2977 LCR 244
Wortham, TX 76693
Mailing address
PO Box 254
Wortham, TX 76693-0254
Phone (903) 388-6231
Other practice location 1
100B W Reunion St
Fairfield, TX 75840-1835
Phone (903) 484-6501
Other providers in Wortham, TX
- Cheree Chapman
- Sharon Kay Hale
- Hevin'S Place Homecare Agency LLC
- Leighton Garrett Patrick
- Wortham I Enterprises, LLC
- Wortham Independent School District
- Wortham Medical Center P a
All providers in Wortham, TX · Professional Counselor in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.