Healthcare Provider Details

I. General information

NPI: 1811397110
Provider Name (Legal Business Name): CASEY KEENBERG LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CASEY LEAVENWORTH-KEENBERG LPC

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 N WYATT DR
TUCSON AZ
85712-2121
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-616-1510
  • Fax: 520-616-1511
Mailing address:
  • Phone: 520-616-1510
  • Fax: 520-616-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-21407
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: