Healthcare Provider Details

I. General information

NPI: 1417673633
Provider Name (Legal Business Name): KEANNA FLOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3681 GREEN RD STE 404
BEACHWOOD OH
44122-5716
US

IV. Provider business mailing address

3681 GREEN RD STE 404
BEACHWOOD OH
44122-5716
US

V. Phone/Fax

Practice location:
  • Phone: 216-342-5484
  • Fax:
Mailing address:
  • Phone: 216-342-5484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2506967
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: