Healthcare Provider Details

I. General information

NPI: 1285823435
Provider Name (Legal Business Name): KAREN KEATING M.ED., LPCC, LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 NARROW GAUGE DR.
DULCE NM
87528
US

IV. Provider business mailing address

PO BOX 546
DULCE NM
87528-0546
US

V. Phone/Fax

Practice location:
  • Phone: 575-759-3162
  • Fax:
Mailing address:
  • Phone: 505-759-3162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0102151
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0099501
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: