Doctor Name: | KAISHA KEITH |
NPI Number: | 1326286980 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC , LCPC |
License Number: | LC3024 |
Business Practice Address: | 14100 Magellan Plz 14100 Magellan Plaza Maryland Heights, MO - 630434644 |
Business Phone Number: | 8004621812 |
Business Fax Number: | |
Mailing Address: | 14100 Magellan Plz, MARYLAND HEIGHTS |
State: | MO |
Postal Code: | 630434644 |
Phone Number: | 8004621812 |
Fax Number: | |
NPI Enumeration Date: | 02/04/2009 |
NPI Last Update Date: | 03/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LC3024 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |