Healthcare Provider Details

I. General information

NPI: 1376866848
Provider Name (Legal Business Name): KEITH WESTERFIELD PHD, MP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 MAIN ST
ZACHARY LA
70791-4038
US

IV. Provider business mailing address

30575 OLD BATON ROUGE HIGHWAY
ALBANY LA
70711-3902
US

V. Phone/Fax

Practice location:
  • Phone: 225-306-2055
  • Fax:
Mailing address:
  • Phone: 225-306-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number013247
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number013247
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number301066
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number013247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: