MEDICARE: MR. ALAN D KECK PSY.D

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1518962810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN D KECK PSY.D

Provider Business Mailing Address
First Line	:	125 WEST PINEVIEW STREET
Second Line	:	SUITE 1005
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2060
Country	:	US
Telephone Number	:	407-644-2000
Fax Number	:	407-644-3484

Provider Business Practice Location Address
First Line	:	125 WEST PINEVIEW STREET
Second Line	:	SUITE 1005
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2060
Country	:	US
Telephone Number	:	407-644-2000
Fax Number	:	407-644-3484

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	08/23/2018

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