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NPI Code Detail

MEDICARE: MR. CHRISTOPHER DEGRAFFENRIED KEENAN JR. BCBA

MEDICARE: MR. CHRISTOPHER DEGRAFFENRIED KEENAN JR. BCBA
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
1103K00000XBehavior Analyst1-16-21983

General Provider Information

NPI Number : 1407219165
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRISTOPHER DEGRAFFENRIED KEENAN JR. BCBA
Provider Business Mailing Address
First Line : PO BOX 7514
Second Line :
City : COLUMBIA
State : SC
Zip : 29202-7514
Country : US
Telephone Number : 803-929-0011
Fax Number : 803-569-1054
Provider Business Practice Location Address
First Line : 1505 BLANDING ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29201-2906
Country : US
Telephone Number : 803-929-0011
Fax Number : 803-569-1054
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2016
Last Update Date : 04/30/2017

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