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General NPI Number Information
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NPI Number | 1346377611
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Entity Type | Individual
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Provider Name | JENNIFER KEITH PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 3535 ROSWELL RD STE 63
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City | MARIETTA
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State | GA
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Zip | 30062-8828
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Country | US
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Telephone | 404-585-4940
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Fax |
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Provider Business Mailing Address
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Address Line | 3434 WOODSHIRE XING
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City | MARIETTA
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State | GA
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Zip | 30066-8720
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Country | US
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Telephone | 404-274-0387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY002996
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License Number State | GA
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