Provider Demographics
NPI:1093940009
Name:KECK, SARAH ELIZABETH (BS,CACIII)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:KECK
Suffix:
Gender:F
Credentials:BS,CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1007
Mailing Address - Country:US
Mailing Address - Phone:970-221-4040
Mailing Address - Fax:970-221-3060
Practice Address - Street 1:1644 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1007
Practice Address - Country:US
Practice Address - Phone:970-221-4040
Practice Address - Fax:970-221-3060
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6762101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)