1952346751 NPI number — MRS. AGNES KATHLEEN MCKEEN LPC

Table of content: MRS. AGNES KATHLEEN MCKEEN LPC (NPI 1952346751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952346751 NPI number — MRS. AGNES KATHLEEN MCKEEN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKEEN
Provider First Name:
AGNES
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLAVEN-MCKEEN
Provider Other First Name:
AGNES
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1952346751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 SUN TEMPLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35758-8643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-975-4291
Provider Business Mailing Address Fax Number:
256-429-9411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 SHAE PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-3597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-701-5651
Provider Business Practice Location Address Fax Number:
256-429-9411
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  2264 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2264 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: S-836 . This is a "THE ASSOCIATION FOR PLAY THERAPY, INC. REGISTERED PLAY THERAPIST AND SUPERVISOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 206738 . This is a "NATIONAL BOARD FOR CERTIFIED COUNSELORS, INC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 2264 . This is a "THE BOARD OF EXAMINERS IN COUNSELING STATE OF ALABAMA-LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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