Healthcare Provider Details

I. General information

NPI: 1174759781
Provider Name (Legal Business Name): PHOEBE KEERAN MA -COUNSELING PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81-6587 MAMALAHOA HWY BLDG C
KEALAKEKUA HI
96750-8133
US

IV. Provider business mailing address

91-1841 FORT WEAVER RD
EWA BEACH HI
96706-1909
US

V. Phone/Fax

Practice location:
  • Phone: 808-323-2664
  • Fax: 808-323-2999
Mailing address:
  • Phone: 808-681-3500
  • Fax: 808-681-1486

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: