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General NPI Number Information
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NPI Number | 1518804244
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Entity Type | Individual
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Provider Name | KEAGAN THERON
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Gender | Male
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Dates
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Enumeration Date | 04/30/2026
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Last Update Date | 04/30/2026
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Provider Practice Location Address
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Address Line | 1415 W 51ST ST UNIT 1
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City | AUSTIN
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State | TX
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Zip | 78756-2659
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Country | US
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Telephone | 512-201-4501
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Fax |
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Provider Business Mailing Address
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Address Line | 14110 KELLYWOOD LN
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City | HOUSTON
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State | TX
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Zip | 77079-6806
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Country | US
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Telephone | 713-515-1835
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | TX
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