MEDICARE: TANYA MCKEITHEN LCSW

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	0904006290	VA

General Provider Information

NPI Number	:	1821378696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA MCKEITHEN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 35229
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-0229
Country	:	US
Telephone Number	:	804-592-4751
Fax Number	:	804-592-4752

Provider Business Practice Location Address
First Line	:	8014 MIDLOTHIAN TPKE
Second Line	:	SUITE 200-A
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5291
Country	:	US
Telephone Number	:	804-592-4751
Fax Number	:	804-592-4752

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

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	12/17/2025

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