Healthcare Provider Details

I. General information

NPI: 1215863295
Provider Name (Legal Business Name): MS. BONNIE KEENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N ORACLE RD STE 240
TUCSON AZ
85704-7738
US

IV. Provider business mailing address

5601 N MARIA DR
TUCSON AZ
85704-5925
US

V. Phone/Fax

Practice location:
  • Phone: 520-524-4757
  • Fax:
Mailing address:
  • Phone: 520-909-3701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAC-23340
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: