Healthcare Provider Details

I. General information

NPI: 1225907934
Provider Name (Legal Business Name): PAUL KECK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3644 CARROLLTON AVE
INDIANAPOLIS IN
46205-3542
US

IV. Provider business mailing address

3644 CARROLLTON AVE
INDIANAPOLIS IN
46205-3542
US

V. Phone/Fax

Practice location:
  • Phone: 317-440-8198
  • Fax:
Mailing address:
  • Phone: 317-440-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012394A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: