Healthcare Provider Details

I. General information

NPI: 1710698782
Provider Name (Legal Business Name): KEENAN SHIMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 N DURHAM AVE
GALLATIN TN
37066-2756
US

IV. Provider business mailing address

312 N DURHAM AVE
GALLATIN TN
37066-2756
US

V. Phone/Fax

Practice location:
  • Phone: 615-249-4409
  • Fax:
Mailing address:
  • Phone: 615-249-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: