MEDICARE: MRS. LINDA LEE KEENE LCSW ACP

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	1041C0700X	Clinical Social Worker	S09093	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0088HE	OTHER		BCBS

General Provider Information

NPI Number	:	1669541405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA LEE KEENE LCSW ACP

Provider Business Mailing Address
First Line	:	6518 PEBBLE BEACH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-2403
Country	:	US
Telephone Number	:	281-893-8435
Fax Number	:

Provider Business Practice Location Address
First Line	:	3845 FM 1960 WEST
Second Line	:	SUITE 250
City	:	HOUSTON
State	:	TX
Zip	:	77068-3548
Country	:	US
Telephone Number	:	281-537-1867
Fax Number	:	281-537-2253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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