Healthcare Provider Details

I. General information

NPI: 1154657773
Provider Name (Legal Business Name): KESHIA SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 W VICTORIA ST 105
LONG BEACH CA
90805-2175
US

IV. Provider business mailing address

4701 CLAIR DEL AVE 820
LONG BEACH CA
90807-1378
US

V. Phone/Fax

Practice location:
  • Phone: 323-242-5000
  • Fax:
Mailing address:
  • Phone: 310-347-9165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: