Provider Demographics
NPI:1225291016
Name:KEATING, MARY JANE (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:KEATING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 W 41ST AVE
Mailing Address - Street 2:#9
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5080
Mailing Address - Country:US
Mailing Address - Phone:720-422-7227
Mailing Address - Fax:
Practice Address - Street 1:900 S BROADWAY
Practice Address - Street 2:#100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4198
Practice Address - Country:US
Practice Address - Phone:303-603-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO535101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health