MEDICARE: KATHERINE KEELING BEHAVIORAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1164274338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHERINE KEELING BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	3250 TAYLOR ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-2142
Country	:	US
Telephone Number	:	618-960-6535
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 TAYLOR ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-2142
Country	:	US
Telephone Number	:	618-960-6535
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHERINE KEELING
Credential	:	LPC
Telephone Number	:	612-465-9668

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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