1669541405 NPI number — MRS. LINDA LEE KEENE LCSW ACP

Table of content: MRS. LINDA LEE KEENE LCSW ACP (NPI 1669541405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669541405 NPI number — MRS. LINDA LEE KEENE LCSW ACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEENE
Provider First Name:
LINDA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW ACP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669541405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6518 PEBBLE BEACH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77069-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-893-8435
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3845 FM 1960 WEST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77068-3548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-537-1867
Provider Business Practice Location Address Fax Number:
281-537-2253
Provider Enumeration Date:
11/07/2006

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: 1041C0700X , with the licence number:  S09093 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0088HE . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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