Provider Demographics
NPI:1710878798
Name:KEASTER, BENJAMIN ROGER-BIGGER
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROGER-BIGGER
Last Name:KEASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:SPRING ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49283-9703
Mailing Address - Country:US
Mailing Address - Phone:517-262-6400
Mailing Address - Fax:
Practice Address - Street 1:9825 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:SPRING ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49283-9619
Practice Address - Country:US
Practice Address - Phone:517-258-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010898401041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical