Healthcare Provider Details

I. General information

NPI: 1851968200
Provider Name (Legal Business Name): ASHLEY LAUREN KECKEISEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 S CIRCLE DR
COLORADO SPRINGS CO
80906-4113
US

IV. Provider business mailing address

1702 LORRAINE ST APT A2
COLORADO SPRINGS CO
80905-2160
US

V. Phone/Fax

Practice location:
  • Phone: 719-540-2100
  • Fax:
Mailing address:
  • Phone: 231-519-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0021482
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: