MEDICARE: KEITH ALLEN BLACKWELL

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	225400000X	Rehabilitation Practitioner		CA
2	390200000X	Student in an Organized Health Care Education/Training Program	1912380437	CA
3	106H00000X	Marriage & Family Therapist	122399	CA

General Provider Information

NPI Number	:	1912380437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH ALLEN BLACKWELL

Provider Business Mailing Address
First Line	:	42455 10TH ST W STE 103
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-7060
Country	:	US
Telephone Number	:	661-341-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	42455 10TH ST W STE 103
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-7060
Country	:	US
Telephone Number	:	661-341-3900
Fax Number	:

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

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	10/13/2020

Similar Medicare Providers

1497843932 — MS. GERALDINE ANNE WATTS M.A
Practice Location Address:

42455 10TH ST W STE 105
LANCASTER, CA
93534-7060

Practice Phone: 661-478-1685
Practice Fax: 661-522-7754

1881725596 — MRS. CASSANDRA J HALL MS, MFT
Practice Location Address:

42455 10TH ST W STE 103
LANCASTER, CA
93534-7060

Practice Phone: 661-341-3900
Practice Fax:

1306979042 — TYEAST MONIQUE BROWN M.S
Practice Location Address:

42455 10TH ST W STE 103
LANCASTER, CA
93534-7060

Practice Phone: 661-341-3900
Practice Fax: 661-341-3904

1053444554 — SHERYL DIANE SNOW M.ED., CADC-II, LMFT
Practice Location Address:

42455 10TH ST W STE 101
LANCASTER, CA
93534-7060

Practice Phone: 310-735-1766
Practice Fax:

1477747392 — MS. CYNTHIA ANGELA HARBOUR-LOGAN LCSW
Practice Location Address:

42455 10TH ST W STE 103
LANCASTER, CA
93534-7060

Practice Phone: 661-483-2225
Practice Fax:

1720225360 — PATHWAYS COMMUNITY SERVICES LLC
Practice Location Address:

42455 10TH ST W , SUITE 103
LANCASTER, CA
93534-7060

Practice Phone: 661-341-3900
Practice Fax: 661-341-3904

Directions to “ KEITH ALLEN BLACKWELL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.