Healthcare Provider Details

I. General information

NPI: 1407396187
Provider Name (Legal Business Name): KEEGAN FERRIS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MONROE AVE NW STE 319
GRAND RAPIDS MI
49503-1451
US

IV. Provider business mailing address

150 BURTON ST SE APT 2
GRAND RAPIDS MI
49507
US

V. Phone/Fax

Practice location:
  • Phone: 616-275-4646
  • Fax:
Mailing address:
  • Phone: 765-749-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberF620465744062
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451019344
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: