Healthcare Provider Details

I. General information

NPI: 1265586507
Provider Name (Legal Business Name): BETH KEEN PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/27/2021
Certification Date: 03/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10149 N 92ND ST STE 103
SCOTTSDALE AZ
85258-4557
US

IV. Provider business mailing address

9001 E SAN VICTOR DR UNIT 1024
SCOTTSDALE AZ
85258-5385
US

V. Phone/Fax

Practice location:
  • Phone: 480-430-0192
  • Fax:
Mailing address:
  • Phone: 480-430-0192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3344
License Number StateAZ

VIII. Authorized Official

Name: BETHANNE KEEN
Title or Position: OWNER/MANAGER
Credential: PHD
Phone: 480-430-0192