Provider Demographics
NPI:1124243423
Name:KEENAN, CHARLES WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:KEENAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4102
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75429-4102
Mailing Address - Country:US
Mailing Address - Phone:903-886-4156
Mailing Address - Fax:
Practice Address - Street 1:1800 TEAGUE DR
Practice Address - Street 2:SUITE 508
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2640
Practice Address - Country:US
Practice Address - Phone:903-813-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15295103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical