Healthcare Provider Details

I. General information

NPI: 1891358487
Provider Name (Legal Business Name): JUSTIN KEENEY LPCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3757 FISHCREEK RD
STOW OH
44224-5404
US

IV. Provider business mailing address

960 GRAHAM RD STE 3
CUYAHOGA FALLS OH
44221-1155
US

V. Phone/Fax

Practice location:
  • Phone: 330-606-9262
  • Fax: 330-606-9262
Mailing address:
  • Phone: 330-606-9262
  • Fax: 234-678-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2303315-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: