Provider Demographics
NPI:1427102458
Name:HUGHES, KEITH G (PHD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:G
Last Name:HUGHES
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 1:1706 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-2039
Mailing Address - Country:US
Mailing Address - Phone:614-252-4800
Mailing Address - Fax:614-251-6005
Practice Address - Street 1:1706 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-2039
Practice Address - Country:US
Practice Address - Phone:614-252-4800
Practice Address - Fax:614-251-6005
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5610103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist