Provider Demographics
NPI:1215284237
Name:KEEN, MISTI (MS)
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:
Last Name:KEEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 S BOUTWELL RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HOME
Mailing Address - State:AL
Mailing Address - Zip Code:36030-5327
Mailing Address - Country:US
Mailing Address - Phone:334-371-5848
Mailing Address - Fax:334-371-5849
Practice Address - Street 1:415 E COMMERCE ST STE 205
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-2328
Practice Address - Country:US
Practice Address - Phone:334-371-5848
Practice Address - Fax:334-371-5849
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11871101YP2500X
AL3395101YP2500X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)