Individual
JOHN ALLEN KEOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
RR 4 BOX 658, BUTLER, MO 64730-9458
(660) 679-4421
(660) 679-4421
Mailing address
RR 4 BOX 658, PO BOX 472, BUTLER, MO 64730-9458
(660) 679-4421
(660) 679-4421
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
01651
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031336
DDS VENDOR NUMBER
MO
Enumeration date
05/01/2007
Last updated
07/09/2007
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