Provider Demographics
NPI:1366876104
Name:KEENAN, ALEXANDRAH LYNN (LCSW, LSUDC)
Entity type:Individual
Prefix:
First Name:ALEXANDRAH
Middle Name:LYNN
Last Name:KEENAN
Suffix:
Gender:F
Credentials:LCSW, LSUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W HILTON DR STE 4
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2203
Mailing Address - Country:US
Mailing Address - Phone:435-680-2726
Mailing Address - Fax:
Practice Address - Street 1:315 W HILTON DR STE 4
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2203
Practice Address - Country:US
Practice Address - Phone:435-680-2726
Practice Address - Fax:435-414-6584
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8258269-6006101YA0400X
UT8258269-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)