Provider Demographics
NPI:1073661195
Name:KEESLING, JEANETTE LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:LYNN
Last Name:KEESLING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:KEESLING
Other - Last Name:MORETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15810 LOS GATOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3315
Mailing Address - Country:US
Mailing Address - Phone:408-354-9956
Mailing Address - Fax:408-354-9956
Practice Address - Street 1:15810 LOS GATOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3315
Practice Address - Country:US
Practice Address - Phone:408-354-9956
Practice Address - Fax:408-354-9956
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18398106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist