MEDICARE: KHRISTIAN KEETON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1275114613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHRISTIAN KEETON

Provider Business Mailing Address
First Line	:	7246 REMMET AVE
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-1531
Country	:	US
Telephone Number	:	818-206-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 D ST
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-5952
Country	:	US
Telephone Number	:	530-742-7747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2021
Last Update Date	:	04/17/2021

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Directions to “ KHRISTIAN KEETON ” Practice Location

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