| Keeley Kooken Msw Lcsw Llc | |
|
511 Cedar Ridge Rd Monroe GA 30656-4617 | |
| (404) 663-5758 | |
| Not Available |
| Full Name | Keeley Kooken Msw Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 511 Cedar Ridge Rd, Monroe, Georgia |
| Authorized Official Name and Position | Keeley Kooken (OWNER) |
| Authorized Official Contact | 4046635758 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keeley Kooken Msw Lcsw Llc 511 Cedar Ridge Rd Monroe GA 30656-4617 Ph: (404) 663-5758 | Keeley Kooken Msw Lcsw Llc 511 Cedar Ridge Rd Monroe GA 30656-4617 Ph: (404) 663-5758 |
| NPI Number | 1194464651 |
|---|---|
| Provider Enumeration Date | 06/02/2022 |
| Last Update Date | 06/02/2022 |
| Certification Date | 06/02/2022 |
| Medicare PECOS PAC ID | 3072991785 |
|---|---|
| Medicare Enrollment ID | O20220725001955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194464651 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Keeley Danielle Kooken |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265900070 PECOS PAC ID: 8426448325 Enrollment ID: I20211208002983 |
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