Provider Demographics
NPI:1235811761
Name:KEENER-HOLLENBECK, HELENA RAE
Entity Type:Individual
Prefix:MRS
First Name:HELENA
Middle Name:RAE
Last Name:KEENER-HOLLENBECK
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 1:1100 W NEWARK RD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-9449
Mailing Address - Country:US
Mailing Address - Phone:810-358-0373
Mailing Address - Fax:
Practice Address - Street 1:1100 W NEWARK RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-9449
Practice Address - Country:US
Practice Address - Phone:810-358-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBACB851331106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician