Provider Demographics
NPI:1043582059
Name:KEEN, STEFANIE MICHELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:MICHELE
Last Name:KEEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PLANTATION CT
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4442
Mailing Address - Country:US
Mailing Address - Phone:864-573-5238
Mailing Address - Fax:
Practice Address - Street 1:39 PLANTATION CT
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4442
Practice Address - Country:US
Practice Address - Phone:864-573-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC978103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical