Provider Demographics
NPI:1083365712
Name:GROVES, KEANA
Entity Type:Individual
Prefix:
First Name:KEANA
Middle Name:
Last Name:GROVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 WIGGINS LOOP RD STE B
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-9795
Mailing Address - Country:US
Mailing Address - Phone:601-697-8392
Mailing Address - Fax:
Practice Address - Street 1:422 WIGGINS LOOP RD STE B
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-9795
Practice Address - Country:US
Practice Address - Phone:601-697-8392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst