Provider Demographics
NPI:1114341443
Name:KEOWN, DOUGLAS M (LSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:KEOWN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S EDWIN C MOSES BLVD
Mailing Address - Street 2:NW BLDG,, 1ST FLOOR
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3424
Mailing Address - Country:US
Mailing Address - Phone:937-224-4646
Mailing Address - Fax:937-224-1625
Practice Address - Street 1:601 S EDWIN C MOSES BLVD
Practice Address - Street 2:NW BLDG,, 1ST FLOOR
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3424
Practice Address - Country:US
Practice Address - Phone:937-224-4646
Practice Address - Fax:937-224-1625
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1303603104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker