Healthcare Provider Details

I. General information

NPI: 1164128856
Provider Name (Legal Business Name): KEATON ALBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 S WESTERN AVE
MARION IN
46953-5778
US

IV. Provider business mailing address

5230 S WESTERN AVE
MARION IN
46953-5778
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-2208
  • Fax: 765-674-3273
Mailing address:
  • Phone: 765-674-2208
  • Fax: 765-674-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: