Provider Demographics
NPI:1043331226
Name:MCKEEVER, JAMES EDWIN (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWIN
Last Name:MCKEEVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:345 KNECHTEL WAY NE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2860
Mailing Address - Country:US
Mailing Address - Phone:206-842-9949
Mailing Address - Fax:206-780-0824
Practice Address - Street 1:345 KNECHTEL WAY NE
Practice Address - Street 2:SUITE 111
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2860
Practice Address - Country:US
Practice Address - Phone:206-842-9949
Practice Address - Fax:206-780-0824
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA1300103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent