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General NPI Number Information
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NPI Number | 1770346330
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Entity Type | Individual
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Provider Name | KEITWEN MONIQUE CARR
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Gender | Female
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 2550 W UNION HILLS DR
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City | PHOENIX
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State | AZ
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Zip | 85027-5163
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Country | US
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Telephone | 323-205-7088
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Fax | 833-419-0181
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Provider Business Mailing Address
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Address Line | 1635 W MOSS AVE
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City | PEORIA
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State | IL
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Zip | 61606-1642
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Country | US
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Telephone | 623-237-1546
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-24113
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License Number State | AZ
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