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NPI Code Detail

MEDICARE: MS. KIMBERLY LUKE KEEN LMFT

MEDICARE: MS. KIMBERLY LUKE KEEN LMFT
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
1101YM0800XMental Health CounselorMFT001167GA

General Provider Information

NPI Number : 1891497053
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY LUKE KEEN LMFT
Provider Business Mailing Address
First Line : 395 PAGE RD
Second Line :
City : ROSSVILLE
State : GA
Zip : 30741-3287
Country : US
Telephone Number : 229-424-8729
Fax Number :
Provider Business Practice Location Address
First Line : 1638 BATTLEFIELD PKWY
Second Line :
City : FORT OGLETHORPE
State : GA
Zip : 30742-4016
Country : US
Telephone Number : 706-841-0500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2023
Last Update Date : 03/21/2023

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