Healthcare Provider Details

I. General information

NPI: 1699826909
Provider Name (Legal Business Name): MICHAEL MCKEEHAN LPCC, LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 MARKET ST
YOUNGSTOWN OH
44512-6703
US

IV. Provider business mailing address

520 OLD NORTH ST
COLUMBIANA OH
44408-1116
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 330-757-0000
Mailing address:
  • Phone: 330-482-5129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0003768
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: