MEDICARE: GLENN STEVEN MCKEEHAN PCC-S

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	101YM0800X	Mental Health Counselor	E-0900072	OH
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1548569817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN STEVEN MCKEEHAN PCC-S

Provider Business Mailing Address
First Line	:	2653 BONNIE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-1105
Country	:	US
Telephone Number	:	513-515-8823
Fax Number	:

Provider Business Practice Location Address
First Line	:	2653 BONNIE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-1105
Country	:	US
Telephone Number	:	135-515-8823
Fax Number	:

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

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	05/01/2025

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