Healthcare Provider Details

I. General information

NPI: 1386272953
Provider Name (Legal Business Name): CARLY ELIZABETH KEATEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 ALBION ST
DENVER CO
80220-1028
US

IV. Provider business mailing address

2137 N DOWNING ST
DENVER CO
80205-5210
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-4890
  • Fax:
Mailing address:
  • Phone: 303-887-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC.0016116
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: