Provider Demographics
NPI:1568831824
Name:CARNAHAN, KEITH (MA, NCC, CAC II)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:CARNAHAN
Suffix:
Gender:M
Credentials:MA, NCC, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 9TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4575
Mailing Address - Country:US
Mailing Address - Phone:303-772-3853
Mailing Address - Fax:303-484-5417
Practice Address - Street 1:24 9TH AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4575
Practice Address - Country:US
Practice Address - Phone:303-772-3853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0105138101YM0800X
COACB.0008255101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health