Provider Demographics
NPI:1306655410
Name:KEENE, KATELAND (LSW)
Entity type:Individual
Prefix:
First Name:KATELAND
Middle Name:
Last Name:KEENE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1069
Mailing Address - Country:US
Mailing Address - Phone:479-372-2743
Mailing Address - Fax:
Practice Address - Street 1:5150 E MAIN ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2441
Practice Address - Country:US
Practice Address - Phone:614-604-8274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2411733104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker