Healthcare Provider Details

I. General information

NPI: 1164588612
Provider Name (Legal Business Name): DEBORAH ELLEN KEECH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 MAIN ST
SOUTH LANCASTER MA
01561
US

IV. Provider business mailing address

PO BOX 821
SOUTH LANCASTER MA
01561-0821
US

V. Phone/Fax

Practice location:
  • Phone: 978-368-2296
  • Fax:
Mailing address:
  • Phone: 978-302-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6278
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6278
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: