Healthcare Provider Details

I. General information

NPI: 1174088462
Provider Name (Legal Business Name): ELLIOTT HUDSON KEEGAN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 FAIRGROVE AVE
HAMILTON OH
45011-1966
US

IV. Provider business mailing address

8421 SKIFF LN
MAINEVILLE OH
45039-9527
US

V. Phone/Fax

Practice location:
  • Phone: 513-785-4895
  • Fax:
Mailing address:
  • Phone: 504-377-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2404278
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: