MEDICARE: KEITH MCENTIRE

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	1041C0700X	Clinical Social Worker	LMSW-08393T	AZ

General Provider Information

NPI Number	:	1780536649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH MCENTIRE

Provider Business Mailing Address
First Line	:	4303 W VISTA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-1669
Country	:	US
Telephone Number	:	602-465-9254
Fax Number	:

Provider Business Practice Location Address
First Line	:	4303 W VISTA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-1669
Country	:	US
Telephone Number	:	602-465-9254
Fax Number	:

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ KEITH MCENTIRE ” Practice Location

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