MEDICARE: JACQUELINE NICOLE KEEVES LMHC

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	101YM0800X	Mental Health Counselor	11085	MA

General Provider Information

NPI Number	:	1841881059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE NICOLE KEEVES LMHC

Provider Business Mailing Address
First Line	:	1 ROCK POND RD
Second Line	:
City	:	WINDHAM
State	:	NH
Zip	:	03087-2222
Country	:	US
Telephone Number	:	917-584-3858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ROCK POND RD
Second Line	:
City	:	WINDHAM
State	:	NH
Zip	:	03087-2222
Country	:	US
Telephone Number	:	917-584-3858
Fax Number	:

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

Provider Enumeration Date	:	01/30/2021
Last Update Date	:	01/30/2021

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