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General NPI Number Information
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NPI Number | 1548848401
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Entity Type | Individual
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Provider Name | JONATHAN MICHAEL NATHANIEL KEITH LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 401 E CHESTNUT ST UNIT 610
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City | LOUISVILLE
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State | KY
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Zip | 40202-5711
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Country | US
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Telephone | 502-588-4450
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Fax | 502-588-9539
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Provider Business Mailing Address
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Address Line | 335 EAGLE LN
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City | NEW ALBANY
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State | IN
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Zip | 47150-6131
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Country | US
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Telephone | 502-373-6632
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 255584
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License Number State | KY
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