Provider Demographics
NPI:1962517359
Name:KEATING, HUGH M (MA)
Entity type:Individual
Prefix:MR
First Name:HUGH
Middle Name:M
Last Name:KEATING
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089-1915
Mailing Address - Country:US
Mailing Address - Phone:719-989-0179
Mailing Address - Fax:
Practice Address - Street 1:431 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089-1915
Practice Address - Country:US
Practice Address - Phone:719-989-0179
Practice Address - Fax:928-753-1226
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4901101YM0800X
NE3054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ847866Medicaid