Provider Demographics
NPI:1083350706
Name:KEATING, BENJAMIN (LPCC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:KEATING
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 COUNTY LINE RD APT B305
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8539
Mailing Address - Country:US
Mailing Address - Phone:303-351-2513
Mailing Address - Fax:
Practice Address - Street 1:2503 WALNUT ST STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5745
Practice Address - Country:US
Practice Address - Phone:303-351-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health