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General NPI Number Information
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NPI Number | 1568999050
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Entity Type | Organization
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Legal Business Name | PHILLIP S KECK, PHD, LLC
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 681 HIOAKS RD STE E
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City | RICHMOND
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State | VA
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Zip | 23225-4043
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Country | US
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Telephone | 804-420-9189
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Fax | 844-308-5846
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Provider Business Mailing Address
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Address Line | PO BOX 13650
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City | RICHMOND
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State | VA
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Zip | 23225-8650
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Country | US
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Telephone | 804-640-6848
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Fax |
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Authorized Official
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Title or Position | DIRECTOR AND CEO
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Name | PHILLIP KECK
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Credential | PHD
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Telephone | 804-640-6848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005353
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License Number State | VA
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